In-hospital day-by-day systolic blood pressure variability during rehabilitation: a marker of adverse outcome in secondary prevention after myocardial revascularization

Importance of anemia in heart failure over blood pressure variability

BACKGROUND

The evaluation of arteriosclerosis (vascular function) is important when treating heart failure (HF). Vascular dysfunction is associated with anemia through renal function and endothelial nitric oxide synthase. Additionally, blood pressure (BP) variability (BPV) caused by vascular dysfunction is also associated with HF prognosis. However, how anemia and BPV may affect HF prognosis is unclear.

METHODS

Between January 2012 and July 2018, 214 patients with HF were hospitalized. The cardio-ankle vascular index (CAVI) as an index of arteriosclerosis of these patients was measured. The patients were divided into the elevated and preserved CAVI groups. We investigated the factors related to major adverse cardiovascular events (MACEs) as cardiovascular death or rehospitalization within 1 year after discharge.

RESULTS

In the elevated CAVI group, significant differences in body mass index (BMI), BPV, left ventricular dimension, and hemoglobin levels were observed between patients with and without MACEs. In the preserved CAVI group, significant differences in BMI, diastolic/mean BP, and hemoglobin levels were observed between those with and without MACEs. The multivariate analysis showed an independent association between hemoglobin levels and MACE occurrence in both the elevated and preserved CAVI groups (elevated CAVI group: hazard ratio [HR] = 0.800, p = .045 [model 1], HR = 0.802, p = .035 [model 2]; preserved CAVI group: HR = 0.783, p = .049 [model 1], HR = 0.752, p = .023 [model 2], and HR = 0.754, p = .024 [model 3]).

CONCLUSIONS

Anemia was independently associated with HF prognosis with or without arteriosclerosis.

Pulse Wave Velocity and Blood Pressure Variability as Prognostic Indicators in Very Elderly Patients

There is scarce evidence for the prognostic importance of hemodynamic measures, such as blood pressure (BP), BP variability, and arterial stiffness, in the very elderly population with advanced chronic conditions. We aimed to evaluate the prognostic importance of 24 h BP, BP variability, and arterial stiffness in a cohort of very elderly patients admitted to the hospital due to a decompensated chronic disease. We studied 249 patients older than 80 (66% women; 60% congestive heart failure). Noninvasive 24 h monitoring was used to determine 24 h brachial and central BP, BP and heart rate variabilities, aortic pulse wave velocity, and BP variability ratios during admission. The primary outcome was 1-year mortality. Aortic pulse wave velocity (3.3 times for each SD increase) and BP variability ratio (31% for each SD increase) were associated with 1-year mortality, after adjustments for clinical confounders. Increased systolic BP variability (38% increase for each SD change) and reduced heart rate variability (32% increase for each SD change) also predicted 1-year mortality. In conclusion, increased aortic stiffness and BP and heart rate variabilities predict 1-year mortality in very elderly patients with decompensated chronic conditions. Measurements of such estimates could be useful in the prognostic evaluation of this specific population.

Day-by-day blood pressure variability in hospitalized patients with COVID-19

In a retrospective analysis, the authors investigated day-by-day blood pressure variability (BPV) and its association with clinical outcomes (critical vs. severe and discharged) in hospitalized patients with COVID-19. The study participants were hospitalized in Tongji Hospital, Guanggu Branch, Wuhan, China, between February 1 and April 1, 2020. BPV was assessed as standard derivation (SD), coefficient of variation (CV), and variability independent of mean (VIM). The 79 participants included 60 (75.9%) severe patients discharged from the hospital after up to 47 days of hospitalization, and 19 (24.1%) critically ill patients transferred to other hospitals for further treatment (n = 13), admitted to ICU (n = 3) or died (n=3). Despite similar use of antihypertensive medication (47.4% vs. 41.7%) and mean levels of systolic/diastolic blood pressure (131.3/75.2 vs. 125.4/77.3 mmHg), critically ill patients, compared with severe and discharged patients, had a significantly (p ≤ .04) greater variability of systolic (SD 14.92 vs. 10.84 mmHg, CV 11.39% vs. 8.56%, and VIM 15.15 vs. 10.75 units) and diastolic blood pressure (SD 9.38 vs. 7.50 mmHg, CV 12.66% vs. 9.80%, and VIM 9.33 vs. 7.50 units). After adjustment for confounding factors, the odds ratios for critical versus severe and discharged patients for systolic BPV were 3.41 (95% confidence interval [CI] 1.20-9.66, p = .02), 4.09 (95% CI 1.14-14.67, p = .03), and 2.81 (95% CI 1.12-7.05, p = .03) for each 5-mmHg increment in SD, 5% increment in CV, and 5-unit increment in VIM, respectively. Similar trends were observed for diastolic BPV indices (p ≤ .08). In conclusion, in patients with COVID-19, BPV was greater and associated with worse clinical outcomes.