Differences in blood pressure riser pattern in patients with acute heart failure with reduced mid‐range and preserved ejection fraction

Abstract

AimsHeart failure (HF) is classified into three types according to left ventricular ejection fraction (EF). The effect of blood pressure (BP) on the pathogenesis of each type is assumed to be different. However, the association between the prognosis of each type of HF and abnormal BP variations assessed by ambulatory BP monitoring (ABPM), such as nocturnal hypertension and the riser pattern, remains unclear.Methods and resultsWe studied 325 consecutive patients with decompensated HF who were acutely admitted to our hospital and underwent ABPM at discharge. During a mean follow‐up of 30.0 months, 52 cardiovascular and 112 all‐cause deaths occurred. The Cox proportional hazards model showed that the mean values of 24 h, awake, and sleep‐time systolic BP (SBP), and abnormal 24 h ABPM patterns, such as nocturnal hypertension and non‐dipper pattern, were not associated with either all‐cause or cardiovascular mortality in patients with HF with reduced EF (HFrEF), HF with mid‐range EF (HFmrEF), or HF with preserved EF (HFpEF), except for sleep‐time SBP in HFrEF. However, the riser pattern was a significant and independent predictor of all‐cause and cardiovascular deaths in patients with HFpEF (hazard ratio, 2.01; 95% confidence interval, 1.12–3.62; 0.0200; and hazard ratio, 2.48; 95% confidence interval, 1.08–5.90; 0.0332, respectively). Sleep‐time pulse rate was similarly decreased in both the riser and non‐riser groups.ConclusionsThe riser pattern of SBP was associated with an increased risk of adverse outcomes among patients with HFpEF but not HFrEF or HFmrEF.

Predominant subtype of heart failure after acute myocardial infarction is heart failure with non‐reduced ejection fraction

“…We also conducted another study in patients with ADHF, known as the Nara Registry and Analyses for Heart Failure cohort study (NARA-HF study). NARA-HF study found that 31% of patients with a history of AMI were classified as HFpEF, 13 supporting the present findings on the frequency of HFpEF after AMI. In contrast, only 18% of patients with HFpEF CI, confidence interval.…”

“…Earlier studies, which investigated the frequency of HF and mortality following AMI using electronic health records, showed that approximately 16–24% of patients with a history of AMI were rehospitalized during the 3–4 year follow‐up after index hospitalization 10,11 . Conversely, the current registries of acute decompensated HF (ADHF) report that approximately 7.5–25% of patients have a history of AMI 12,13 …”

Differential Effect of the Morning Blood Pressure Surge on Prognoses Between Heart Failure With Reduced and Preserved Ejection Fractions

“…Decreased stroke volume cannot maintain sufficient blood that ABPM had prognostic significance even during hospitalization. 26 Second, the doses of antihypertensive medications and the timing of drug administration could influence MBPS. However, multiple drugs are usually prescribed to HF patients.…”

Effect of the Sodium-Glucose Cotransporter 2 Inhibitor Canagliflozin for Heart Failure With Preserved Ejection Fraction in Patients With Type 2 Diabetes

“…Some studies recently found that the subgroup of patients with HFpEF and the night-time riser pattern of blood pressure, as determined ambulatory blood pressure monitoring, was at higher risk for CV events and HHF. 39 , 40 The use of SGLT2 inhibitors may be more promising in these patients, because these drugs likely reduce night-time blood pressure in patients with T2D and uncontrolled nocturnal hypertension. 41…”