Аmbulatory blood pressure monitoring in patients with heart failure with preserved ejection fraction
Summary. Inadequate control of blood pressure (BP) is an important factor of the development of chronic heart failure (CHF) with preserved ejection fraction (pEF). There is evidence that the level of mean ambulatory systolic blood pressure (SBP), unlike the office SBP, is independently associated with the development of CHF with pEF. Objective — to study 24-h profile of BP in elderly hypertensive patients with CHF with pEF. Materials and methods. We enrolled 120 patients (mean age 67.8±1.2 years): 30 patients with essential hypertension (EH) with no signs of CHF and 90 patients with EH complicated by CHF with pEF. They were examined using Doppler echocardiography, ambulatory BP monitoring, 6-minute walk test and brain natriuretic propeptide plasma concentrations. Results and discussion. Increased office SBP was registered in patients of both groups, but the mean levels of 24-h, daytime and nighttime BP were significantly higher in CHF with pEF patients compared to EH patients. Office diastolic BP (DBP) levels were comparable in two groups and did not exceed the recommended range. Therefore, mean 24-h DBP slightly exceeded the upper limits in both groups. The distance of 6-minute walk test does not correlate with office BP. There is no limiting impact of increased BP (in the range up to 154.3±1.4 mmHg) on physical activity in patients with initial stages of CHF. The 24-h pulse BP was higher in CHF with pEF patients (63.2±0,9 mmHg compared with 54,9±1.4 mmHg in EH patients; p<0,05). This fact indicates an increased risk of cardiovascular events in CHF with pEF patients. Among patients with CHF with pEF certain deviation of daily index SAD found in 54 (60.0%), DBP — in 37 (41.1%) patients, whereas among patients with uncomplicated EH — 13 (43.3%) and 6 (20%), respectively. Normal BP circadian rhythm was registered significantly more frequent in EH patients compared with CHF with pEF patients (40 and 17.8% respectively). Abnormal pattern of day/night SBP dynamics was demonstrated by 54 (60.0%), and abnormal pattern of day/night DBP dynamics — by 37 (41.1%) CHF with pEF patients. Among patients with uncomplicated EH abnormal patterns of day/night SBP and DBP were registered in 13 (43.3%) and 6 (20%) cases, respectively. Conclusions. CHF with pEF patients demonstrated insufficient control of both office and 24-h BP. 82.2% of CHF with pEF patients were characterized by pathological types of BP circadian rhythm with dominating «non-dipper» type.