The Association Between On-treatment Ambulatory Central Blood Pressure and Left Ventricular Reverse Remodeling in Heart Failure With Reduced Ejection Fraction

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.

Association of Blood Pressure and Prognosis of Heart Failure With Systolic Dysfunction: A Myth That Should Be Solved

“…Most of the large-scale randomized trials excluded patients with low BP. 2) In this issue of the International Journal of Heart Failure , Ha et al 6) retrospectively analyzed 93 patients with HFrEF who performed ambulatory blood pressure monitoring (ABPM) to investigate the clinical implications of ambulatory central and brachial BP compared to office BP. Although both ambulatory central and brachial BP measurements did not demonstrate an improved prognostication ability compared to office BP measurements, patients who achieved left ventricular reverse remodeling (LVRR) exhibited a higher BP, in line with previous findings.…”