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Candemir M, Kızıltunç E, Nurkoç SG, Cihan B, Şahinarslan A. Predictors of length of hospital stay and in-hospital adverse events in patients with acute decompensated heart failure: in-hospital 24-hour blood pressure monitoring data. Hellenic J Cardiol 2024:S1109-9666(24)00132-5. [PMID: 38925251 DOI: 10.1016/j.hjc.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/12/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE Neurohumoral alterations in heart failure (HF) affect blood pressure variability (BPV) and vascular compliance, but little is known about this subject among patients admitted to the hospital with decompensated HF. This study sought to investigate in-hospital 24-h blood pressure monitoring (BPM)-derived BPV parameters and vascular compliance in patients with decompensated HF and explore the association of these parameters with hospitalization length and in-hospital adverse events. METHODS A 24-h BPM was applied during the first 6 h of admission to the hospital in patients with decompensated HF. Circadian patterns were determined by the study patients. Average real variability (ARV), pulse pressure index (PPI), pulse stiffening ratio (PSR), and ambulatory arterial stiffness index (AASI) values were calculated from in hospital 24-h BPM recordings. Admission and discharge N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, length of hospitalization, and in-hospital adverse events were recorded. RESULTS A total of 167 patients with decompensated HF were included in the study. The dipper group exhibited a greater NT-proBNP decrease with the treatment than the non-dipper group and reverse dipper group. Hospitalization length was shorter in the dipper group than in the non-dipper and reverse dipper groups. Although ARV, AASI, and PSR were independently associated with the length of hospitalization, ARV, AASI, and PPI were independently associated with in-hospital adverse events. CONCLUSION The post-admission in hospital 24-h BPM-derived parameters (dipper pattern, ARV, PPI, PSR, and AASI) of patients admitted to hospital with decompensated HF provide important prognostic information and predict the length of hospital stay.
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Affiliation(s)
- Mustafa Candemir
- Gazi University, Faculty of Medicine, Department of Cardiology, Ankara 06560, Turkey.
| | - Emrullah Kızıltunç
- Gazi University, Faculty of Medicine, Department of Cardiology, Ankara 06560, Turkey
| | | | - Burcu Cihan
- Gazi University, Faculty of Medicine, Department of Cardiology, Ankara 06560, Turkey
| | - Asife Şahinarslan
- Gazi University, Faculty of Medicine, Department of Cardiology, Ankara 06560, Turkey
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García Puig J, Banegas JR. ABPM in patients with heart failure: a long way to go. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:841-842. [PMID: 37717652 DOI: 10.1016/j.rec.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Juan García Puig
- Departamento de Medicina Interna, Universidad Autónoma de Madrid, Madrid, Spain; Servicio de Medicina Interna, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid, Spain.
| | - José R Banegas
- Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid, Madrid, Spain
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de Juan Bagudá J, Rodríguez Chaverri A, Caravaca Pérez P, Aguilar-Rodríguez F, García-Cosío Carmena MD, Mirabet Pérez S, López ML, de la Cruz J, Guerra JM, Segura J, Arribas Ynsaurriaga F, Ruilope LM, Delgado Jiménez JF. Twenty-four hour ambulatory blood pressure monitoring in patients with stable heart failure. Prevalence and associated factors. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:852-861. [PMID: 37182724 DOI: 10.1016/j.rec.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/23/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTION AND OBJECTIVES Hypertension is highly common in heart failure (HF). However, there is limited information on its prevalence, circadian variation, and relationship with the various HF phenotypes. The objective of this study was to describe the prevalence of hypertension and its patterns in HF. METHODS This was a cross-sectional observational study of patients with optimized stable chronic HF. The patients underwent blood pressure (BP) measurement in the office and 24-hour ambulatory monitoring. We estimated the prevalence of hypertension, and its diurnal (controlled, uncontrolled, white coat, and masked) and nocturnal (dipper, nondipper, and reverse dipper) patterns. We also analyzed the factors associated with the different patterns and HF phenotypes. RESULTS From 2017 to 2021, 266 patients were included in the study (mean age, 72±12 years, 67% male, 46% with reduced ejection fraction). Hypertension was present in 83%: controlled in 68%, uncontrolled in 10%, white coat in 10%, and masked in 11%. Among patients with high office BP, 51% had white coat hypertension. Among those with normal office BP, 14% had masked hypertension. The prevalence of dipper, nondipper, and reverse dipper patterns was 31%, 43%, and 26%, respectively. Systolic BP was lower in HF with reduced ejection fraction than in HF with preserved ejection fraction (P <.001). CONCLUSIONS Ambulatory BP monitoring in HF identified white coat hypertension in more than half of patients with high office BP and masked hypertension in a relevant percentage of patients. The distribution of daytime patterns was similar to that of the population without HF in the literature, but most of the study patients had a pathological nocturnal pattern.
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Affiliation(s)
- Javier de Juan Bagudá
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina, Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Madrid, Spain.
| | | | | | - Fernando Aguilar-Rodríguez
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - M Dolores García-Cosío Carmena
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Sonia Mirabet Pérez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIB SANT PAU, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María Luisa López
- Unidad de Hipertensión Arterial, Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Javier de la Cruz
- Instituto de Investigación imas12, Red SAMID-ISCIII, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - José M Guerra
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIB SANT PAU, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julián Segura
- Unidad de Hipertensión Arterial, Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Fernando Arribas Ynsaurriaga
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis Miguel Ruilope
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Laboratorio Traslacional Cardiorrenal y Unidad de Hipertensión Arterial, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Facultad de Ciencias del Deporte, Universidad Europea de Madrid, Madrid, Spain
| | - Juan F Delgado Jiménez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Taş Ü, Taş S, Edem E. The Relationship between Nocturnal Dipping Status, Morning Blood Pressure Surge, and Hospital Admissions in Patients with Systolic Heart Failure. Arq Bras Cardiol 2023; 120:e20220932. [PMID: 37729291 PMCID: PMC10519354 DOI: 10.36660/abc.20220932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/27/2023] [Accepted: 07/17/2023] [Indexed: 09/22/2023] Open
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.
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Affiliation(s)
- Ümmü Taş
- Izmir Demokrasi UniversitesiKarabaglarTurquiaIzmir Demokrasi Universitesi – Cardiology, Karabaglar – Turquia
| | - Sedat Taş
- Manisa Celal Bayar UniversityManisaTurquiaManisa Celal Bayar University – Cardiology, Manisa – Turquia
| | - Efe Edem
- İzmir Tınaztepe UniversityİzmirTurquiaİzmir Tınaztepe University – Cardiology, İzmir – Turquia
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Ha J, Lee CJ, Oh J, Park S, Lee SH, Kang SM. The Association Between On-treatment Ambulatory Central Blood Pressure and Left Ventricular Reverse Remodeling in Heart Failure With Reduced Ejection Fraction. INTERNATIONAL JOURNAL OF HEART FAILURE 2023; 5:150-158. [PMID: 37554693 PMCID: PMC10406559 DOI: 10.36628/ijhf.2023.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 08/10/2023]
Abstract
Background and Objectives Compared to office blood pressure (OBP), central blood pressure (CBP) and ambulatory blood pressure (BP) are known to be better markers for predicting cardiovascular events. We evaluated the association between left ventricular reverse remodeling (LVRR) and ambulatory CBP in heart failure with reduced ejection fraction (HFrEF). Methods This study retrospectively analyzed 93 patients who performed ambulatory CBP and brachial BP (BBP) monitoring from 2018 to 2020 within 1 year after diagnosis of HFrEF at a single tertiary center. We analyzed the association between on-treatment ambulatory BPs and LVRR on follow-up echocardiography. Results The mean age of participants was 59 years; 65.6% were men; mean LVEF was 29%. Ambulatory BP and follow-up echocardiography were done at 143 days (interquartile range [IQR], 64-267) and 454 days (IQR, 281-600) after diagnosis of HF, respectively. Baseline OBP was not different between 2 groups, but ambulatory systolic CBP was significantly higher in the LVRR group than the non-LVRR group (p=0.005). Systolic OBP (odds ratio [OR], 1.029; confidence interval [CI], 1.004-1.055; p=0.026), 24-hour ambulatory systolic CBP (OR, 1.048; CI, 1.015-1.082; p=0.004), and 24-hour ambulatory systolic BBP (OR, 1.049; CI,1.017-1.082; p=0.003) were associated with LVRR. Compared to ambulatory systolic CBP of 110-119 mmHg, 90-99 mmHg showed lower OR for LVRR. Conclusions Low on-treatment ambulatory systolic CBP was closely related to a lower likelihood of LVRR in HFrEF than the normal range. Ambulatory CBP measured during treatment of patients with HFrEF appears to be useful in predicting outcomes.
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Affiliation(s)
- Jaehyung Ha
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Joo Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jaewon Oh
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sungha Park
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Hak Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seok-Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Camafort M, Chung WJ, Shin JH. Role of ambulatory blood pressure monitoring in elderly hypertensive patients. Clin Hypertens 2022; 28:22. [PMID: 35773739 PMCID: PMC9248111 DOI: 10.1186/s40885-022-00205-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/10/2022] [Indexed: 01/02/2023] Open
Abstract
Background Arterial hypertension is facing some changes in the last years. Its prevalence is increasing in elderly subjects. This growing prevalence is due to longer survival of the population worldwide, among other factors. On the other hand, recent guidelines have insisted in the relevance of out of office blood pressure measurements, to improve diagnostic and management of hypertension. Therefore, elderly subjects with hypertension could benefit from out of office blood pressure measurements, like ambulatory blood pressure measurements; nevertheless, there are very few or no specific recommendations regarding this. Aim In this review, we will gather the most important information about this subject. Results As hypertension in the elderly has some specific characteristics related to aging of the cardiovascular system, the most important aspect could be that these characteristics make ambulatory blood pressure measurement suitable for its use in elderly. Among those a higher prevalence of white coat hypertension, white coat phenomenon, and a higher nocturnal blood pressure and higher prevalence of nondipper and riser pattern, represent aspects that should be considered for better diagnostic and an improved management. Conclusion As the prevalence of hypertension will grow in the next years, more studies specifically directed to this subject are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s40885-022-00205-6.
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Affiliation(s)
- Miguel Camafort
- ESH Excellence Hypertension Center, Department of Internal Medicine, Geriatrics Section, Hospital Clinic, University of Barcelona, Barcelona, Spain. .,Research Group on Cardiovascular Risk, Nutrition and Aging, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain. .,Research Group CB06/03/0019, Biomedical Network Research Center in Obesity and Nutrition (CIBER-OBN), Institute of Health Carlos III (ISCIII), Ministry of Science, Innovation and Universities, Madrid, Spain.
| | - Wook-Jin Chung
- Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea.,Gachon Cardiovascular Research Institute, Gachon University, Incheon, Republic of Korea
| | - Jin-Ho Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
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Camafort M, Valdez-Tiburcio O, Wyss F. Hypertension and heart failure with preserved ejection fraction. A past, present, and future relationship. HIPERTENSION Y RIESGO VASCULAR 2022; 39:34-41. [DOI: 10.1016/j.hipert.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
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Coca A. Marcadores pronósticos fiables de la evolución de la insuficiencia cardíaca del anciano: ¿es la monitorización ambulatoria de la presión arterial uno de ellos? Rev Clin Esp 2021. [DOI: 10.1016/j.rce.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Coca A. Reliable prognostic markers for the progression of heart failure in older adults: Is ambulatory blood pressure monitoring one of them? Rev Clin Esp 2021; 221:470-472. [PMID: 34154975 PMCID: PMC8464162 DOI: 10.1016/j.rceng.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 11/29/2022]
Affiliation(s)
- A Coca
- Unidad de Hipertensión y Riesgo Vascular, Servicio de Medicina Interna, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain.
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