Nocturnal hypertension in acute heart failure patients: 24 hours blood pressure pattern

Type of funding sources: None.

It is well defined the prognosis value of the abnormalities in the circadian variation in hypertensive patients. In the phisiopathology of heart failure, neurohumoral mechanism plays an important role. Nevertheless, the circadian variation in nonhypertensive heart failure patients has not been well evaluated.

Our aim was to evaluate 24-h blood pressure patterns and the prevalence of nocturnal hypertension in patients admitted with acute heart failure.

We studied 122 patients with a clinical diagnosis of AHF. We permormed a 24-h  ambulatory blood pressure monitoring as well as an echocardiogram and anaytical test.

122 patients. Mean age: 63 ± 10. Males: 75%. Mean BMI: 30 ± 6 Kg/m2. Associated risk factors: 56,6% hypertension, 40 % dyslipidemia, 34,7% Diabetes, 29,3% obesity, 22,9% smoking. The etiology of HF: ischemic 41,2%;hypertensive 22,7%; dilated cardiomyopathy 20,9%;valvular 8,3%; others 6,9%.Therapeutic regimen applied: RAS blockers 93,4%; betablockers 85,7%; loop diuretic 81%; spironolactone 42,3%; statins 68,4%; antiplatelet/anticoagulant drugs 89%.

The 24 h ABPM measurements are in table 1

The majority of AHF patients (80,4%) have an abnormal pattern of ABPM: Dipper 19,6%, non-dipper 51,1%, riser 0%.The prevalence of nocturnal hypertension was 22,8%.

In our area, AHF patients have optimal control of BP , however, the normal circadian variation in blood pressure is altered in most of them. In addition, nocturnal hypertension is very common in heart failure patients. Ambulatory blood pressure monitoring may be helpful in identified this altered patterns (which could be unrecognized) and may be used to optimise heart failure therapy,  and could be a prognosis marker in this patient group.

Table 1