The Relationship between Nocturnal Dipping Status, Morning Blood Pressure Surge, and Hospital Admissions in Patients with Systolic Heart Failure

Abstract

Background: Hypertension is a known risk factor for developing heart failure. However, there is limited data to investigate the association between morning blood pressure surge (MBPS), dipping status, echocardiographic parameters, and hospital admissions in patients with systolic heart failure.

Objectives: To evaluate the relationship between morning blood pressure surge, non-dipper blood pressure pattern, echocardiographic parameters, and hospital admissions in patients with systolic heart failure.

Methods: We retrospectively analyzed data from 206 consecutive patients with hypertension and a left ventricular ejection fraction below 40%. We divided the patients into two groups according to 24-hour ambulatory blood pressure monitoring (ABPM) results: dippers (n=110) and non-dippers (n=96). Morning blood pressure surge was calculated. Echocardiographic findings and hospital admissions during follow-up were noted. Statistical significance was defined as p < 0.05.

Results: The study group comprised 206 patients with a male predominance and mean age of 63.5 ± 16.1 years. The non-dipper group had significantly more hospital admissions compared to dippers. There was a positive correlation between MBPS and left atrial volume index (r=0.331, p=0.001), the ratio between early mitral inflow velocity and flow propagation velocity (r= 0.326, p=0.001), and the ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/Em) (r= 0.314, p=0.001). Non-dipper BP, MBPS, and E/Em pattern were found to be independently associated with increased hospital admissions.

Conclusion: MBPS is associated with diastolic dysfunction and may be a sensitive predictor of hospital admission in patients with systolic heart failure.

Figura Central. : A relação entre o estado dipping noturno, aumento matinal da pressão arterial e internações hospitalares em pacientes com insuficiência cardíaca sistólica

Figura 1. – Curva ROC (Receiver Operating Characteristic) para pico matinal de pressão arterial e E/Em na predição de internação; o valor de corte ideal para PPAM de 33,25 teve sensibilidade de 75,0% e especificidade de 73,0% área sob a curva característica de operação do receptor: 0,802, o valor de corte ideal para E/Em de 12,8 teve sensibilidade de 72,8% e especificidade de 74,6 % de área sob a curva característica de operação do receptor: 0,805.

Central Illustration. : The relationship between nocturnal dipping status, morning blood pressure and hospital admissions in patients with systolic heart failure

Figure 1. – The receiver operating characteristic (ROC) curve for morning blood pressure surge and E/Em in the prediction of hospital admission; the optimal cut-off value for MBPS of 33.25 had sensitivity of 75.0% and specificity of 73.0% area under receiver operating characteristic curve: 0.802, the optimal cut-off value for E/Em of 12.8 had sensitivity of 72.8% and specificity of 74.6% area under receiver operating characteristic curve: 0.805.