High visit-to-visit SBP variability is a predictor of adverse outcomes in hypertensive patients with chronic heart failure with reduced ejection fraction

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To evaluate visit-to-visit BP variability (BPV) and its prognostic significance in patients with stable heart failure (HF) with reduced ejection fraction (EF<40%).

Material and methods

The study included 100 pts (80 men, age 64,4±9,3 yrs, BP 127,6±15,1/77,9±8,3 mmHg) with stable II-III NYHA class HF (mean EF 32,3±4,3%). Patients received stable treatment with ACE inhibitors, betablockers, spironolactone and furosemide. BP was measured with a validated oscillometric device. Visit-to-visit BPV was calculated as SD for 7 visits during 18 months of unchanged therapy. The endpoints included death, myocardial infarction (MI), stroke, hospitalization for HF.


Visit-to visit systolic and diastolic BPV varied from 2.3 to 20.0 mm Hg and from 1.5 to 13.0 mm Hg, respectively. Thirty seven patients achieved 47 endpoints (21 deaths, 17 hospitalizations for HF, 6 MI and 3 strokes). There was no significant difference between groups with and without endpoints in age, gender, history of MI, baseline BP, severity of HF, EF. The patients with endpoints had higher visit-to-visit systolic BPV (11.2±4.0 vs 9.5±3.5 mm Hg, p<0.05). Nonlinear logistic regression analysis revealed higher risk of adverse outcomes in patients with higher visit-tovisit systolic BPV (OR 1.13, 95% CI 1.0-1.27, p=0.03). Area under curve (AUC) for visit-to-visit systolic BPV>10.9 mmHg was 0.74, 95% CI 0.53-0.94 (sensitivity 72.7%, specificity 80%, p=0.02),


Systolic visit-to-visit BPV was a strong significant predictor of adverse outcomes in patients with stable HF with reduced EF. The threshold of visit-to-visit systolic BPV>10.9 mmHg may be used as prognostic criteria in this patient population.

Key words

Arterial hypertension, chronic heart failure, reduced ejection fraction, visit-to-visit BP variability.