Abstract 13999: Elevated Asleep Blood Pressure is Associated With All-cause and Cardiovascular Mortality in Heart Failure With Preserved Left Ventricular Ejection Fraction (HFpEF) -From Nara-HF Study
Introduction: Abnormal circadian blood pressure (BP) rhythms are one of the risks of cardiovascular diseases and death. However, circadian BP rhythms in heart failure (HF) patients are unclear. Therefore, we examined the relationship between circadian BP rhythms for survival in HF patient. Moreover, we valued the difference of circadian BP rhythms between HF with preserved left ventricular ejection fraction (HFpEF) and HF with reduced left ventricular ejection fraction (HFrEF).
Methods: Of 810 consecutive patients with acute decompensated HF emergently admitted to our hospital, we studied 228 HF patients performed ambulatory blood pressure monitoring (ABPM) at discharge. We examined the relationship between circadian BP rhythms and survival in HFpEF and HFrEF. Kaplan-Meier survival analysis and Cox proportional hazard model were performed to assess outcomes.
Results: During a mean follow-up of 27.9 months, there were 80 deaths from all causes, including 36 deaths from cardiovascular causes. The pattern of circadian BP rhythms was similar between HFpEF and HFrEF. In HFpEF patients, Kaplan-Meier analysis showed that all-cause and cardiovascular death were significantly higher in patients with the pattern of elevated asleep BP (EABP), in which sleep BP exceeded awake BP (log-rank P=0.0298 and P=0.0195, respectively). In a multivariate analysis, EABP pattern was an independent predictor for all-cause and cardiovascular death (HR 2.57; 95% CI 1.09-6.13; P=0.0310 and HR 10.66; 95% CI 1.91-93.9; P=0.0063, respectively) after adjusted by age, hemoglobin and brain natriuretic peptide. However, these findings were not observed in HFrEF.
Conclusions: EABP pattern was associated with increasing risk for adverse outcome in HFpEF patients, but not in HFrEF patients. Although further studies are necessary to elucidate the mechanism, we should pay attention to EABP pattern in HFpEF.
Author Disclosures: T. Ueda: None. Y. Nakada: None. H. Kawata: None. R. Kawakami: None. H. Okura: None. Y. Saito: Research Grant; Significant; Grants-in-Aid for Scientific Research (B), Challenging Exploratory Research (FY 2015), Health, Labour and Welfare Scientific Research. Other Research Support; Modest; Nihon Medi-Physics Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Genzyme Japan K.K., Medtronic, Inc., Pfizer Japan Inc.. Other Research Support; Significant; MSD K.K. a subsidiary of Merck & Co., Inc., Daiichi Sankyo Co., Ltd., Bayer Holding Ltd., Baxter Ltd., Otsuka Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Astellas Pharma Inc., Takeda Pharmaceutical Co., Ltd., Ono Pharmatical Co., Ltd., Teijin Pharma Ltd., Mitsubishi Tanabe Pharma Corporation, Eisai Co., Ltd., ZERIA Pharmaceutical Co., Ltd.. Honoraria; Modest; Otsuka Pharmaceutical Co., Ltd, Takeda Pharmaceutical Co., Ltd, Mitsubishi Tanabe Pharma Corporation, Daiichi Sankyo Co., Ltd, MSD K.K. a subsidiary of Merck & Co., Inc, Novartis Pharma K.K., Bayer Holding Ltd, Kyowa Hakko Kirin Co., Ltd, Astellas Pharma Inc, Ono Pharmatical Co., Ltd, Pfizer Japan Inc.. Consultant/Advisory Board; Modest; Novartis Pharma K.K., Ono Pharmatical Co., Ltd, Pfizer Japan Inc..
- © 2016 by American Heart Association, Inc.