Abstract 12794: Abnormality of Nighttime Blood Pressure as a Novel Prognostic Marker in Patients with Dilated Cardiomyopathy
Background: Blunted nighttime blood pressure fall (NBPF) is considered to be a risk factor of cardiovascular events in hypertensive patients. However little is known about the circadian BP abnormalities in patients with dilated cardiomyopathy (DCM).
Purpose: We studied the relationship between the severity of DCM and NBPF estimated by ambulatory BP monitoring (ABPM), and investigated the prognostic value of NBPF in patients with DCM.
Methods: We enrolled consecutive 78 DCM patients (54 males, mean age of 53.2 years) in this retrospective study. All patients underwent ABPM, laboratory measurements, echocardiogram, and cardiac catheterization. We defined %NBPF as a percent change of mean nighttime BP from mean daytime BP and analyzed the association between %NBPF and pathophysiological parameters. All patients were followed-up and the median follow-up period after ABPM testing was 2.5 years.
Results: The means of left ventricular ejection fraction (LVEF) and brain natriuretic peptide (BNP) level were 30.0% and 222pg/mL. Of all 78 patients, 50 (64%) received ACEi/ARB, 51 (65%) received β-blockers, and 30 (38%) received aldosterone antagonists. Hemoglobin (r=0.28, p=0.013), serum creatinine (r=0.29, p=0.011), serum noradrenaline (r=0.24, p=0.033), and BNP levels (r=0.31, p=0.006) had inverse correlation with %NBPF. Multivariable regression analysis revealed that BNP level was a significant determinant of %NBPF (P=0.013). LVEF, QRS wide, cardiac index, and pulmonary capillary wedge pressure were not associated with %NBPF. In prognostic analysis, the probability of all cause and cardiac deaths were in the lowest % NBPF quartile (%NBPF ≤ 0.49%) group; p=0.024 and p=0.012, respectively (Figure).
Conclusions: The circadian BP abnormality was associated with both DCM severity and prognosis. %NBPF may be a new surrogate and a novel prognostic marker in patients with DCM.
- © 2013 by American Heart Association, Inc.