The Relationship between Nocturnal Dipping Status, Morning Blood Pressure Surge, and Hospital Admissions in Patients with Systolic Heart Failure

Taş, Ümmü; Taş, Sedat; Edem, Efe

doi:10.36660/abc.20220932

Brasil

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Original Article • Arq. Bras. Cardiol. 120 (9) • 2023 • https://doi.org/10.36660/abc.20220932 linkcopy

The Relationship between Nocturnal Dipping Status, Morning Blood Pressure Surge, and Hospital Admissions in Patients with Systolic Heart Failure

Authorship SCIMAGO INSTITUTIONS RANKINGS

Central Illustration

: The relationship between nocturnal dipping status, morning blood pressure and hospital admissions in patients with systolic heart failure

Abstract

Background Hypertension is a known risk factor for developing heart failure. However, there is limited data to investigate the association between morning blood pressure surge (MBPS), dipping status, echocardiographic parameters, and hospital admissions in patients with systolic heart failure.

Objectives To evaluate the relationship between morning blood pressure surge, non-dipper blood pressure pattern, echocardiographic parameters, and hospital admissions in patients with systolic heart failure.

Methods We retrospectively analyzed data from 206 consecutive patients with hypertension and a left ventricular ejection fraction below 40%. We divided the patients into two groups according to 24-hour ambulatory blood pressure monitoring (ABPM) results: dippers (n=110) and non-dippers (n=96). Morning blood pressure surge was calculated. Echocardiographic findings and hospital admissions during follow-up were noted. Statistical significance was defined as p < 0.05.

Results The study group comprised 206 patients with a male predominance and mean age of 63.5 ± 16.1 years. The non-dipper group had significantly more hospital admissions compared to dippers. There was a positive correlation between MBPS and left atrial volume index (r=0.331, p=0.001), the ratio between early mitral inflow velocity and flow propagation velocity (r= 0.326, p=0.001), and the ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/Em) (r= 0.314, p=0.001). Non-dipper BP, MBPS, and E/Em pattern were found to be independently associated with increased hospital admissions.

Conclusion MBPS is associated with diastolic dysfunction and may be a sensitive predictor of hospital admission in patients with systolic heart failure.

Blood Pressure Monitoring, Ambulatory; Arterial Pressure; Heart Failure; Hospitalization

	Dipper (n:110)	Non-dipper (n:96)	p-value
Gender, male(%)	68(61.8)	54(56.3)	0.566^¥
Age (year)	57.0±16.3	60.1±15.8	0.325*
NYHA FC, n (%)			0.094^¥
FC-2	70(63.6)	42(43.8)
FC-3	36(32.7)	44(45.8)
FC-4	4(3.6)	10(10.4)
The number of hospital admission (year)	1.01±0.59	1.72±0.81	<0.001^*
Smoking, n(%)	16(14.5)	16(16.7)	0.767^¥
DM, n(%)	34(30.9)	32(33.3)	0.793^¥
CKD, n(%)	10(9.1)	10(10.4)	0.821^¥
HL, n(%)	22(20.0)	24(25.0)	0.543^¥
CIHD, n(%)	72(65.5)	74(77.1)	0.195^¥
COPD, n(%)	6(5.5)	16(16.7)	0.066^¥
Diuretic, n(%)	82(74.5)	94(94.9)	0.001 ^¥
ACEI-ARB, n(%)	94(85.5)	84(87.5)	0.806^¥
Spironalacton, n(%)	76(69.1)	80(83.3)	0.093^¥
Beta-blocker, n(%)	98(89.1)	94(97.9)	0.076^¥
BNP (pg/ml)	382.5±522.0	461.9±447.9	0.413*

	Dipper (n:110, mmHg)	Non-dipper (n:96, mmHg)	p-value*
Office SBP	127.6±16.1	122.6±20.0	0.164
Office DBP	72.6±8.9	70.2±10.5	0.209
24-h SBP	128.3±10.6	128.9±13.7	0.748
24-h DBP	78.4±7.4	75.7±7.4	0.067
Day-time SBP	130.9±11.7	132.8±14.0	0.472
Day-time DBP	81.2±8.2	78.2±7.9	0.065
Night-time SBP	113.8±13.6	115.4±15.5	0.578
Night-time DBP	72.3±8.4	69.8±8.4	0.137
MBPS	31.1±6.7	32.9±6.3	0.174

	Dipper (n:110)	Non-dipper (n:96)	p-value*
LAVI (ml/m²)	33.1±4.2	38.1±5.7	<0.001
LVEF (%)	30.4±5.4	32.0±6.1	0.155
LVEDD (cm)	6.12±0.59	5.97±0.64	0.232
LVESD (cm)	5.16±0.63	5.21±0.71	0.692
E (cm/s)	102.8±28.2	116.2±33.3	0.029
A (cm/s)	87.7±22.9	88.4±28.6	0.881
E/A ratio	1.26±0.51	1.57±0.91	0.061
DT (ms)	167.2±44.3	159.6±42.2	0.374
VP (cm/s)	37.4±4.2	32.2±4.4	<0.001
IVRT (ms)	132.7±26.1	142.5±43.4	0.164
Em (cm/s)	7.65±2.12	6.30±1.84	0.001
Am (cm/s)	7.12±1.67	7.73±2.64	0.160
E/Em ratio	11.8±4.4	16.4±7.8	0.001
E/VP	2.76±0.75	3.75±1.20	<0.001
Sm (cm/s)	6.84±1.07	6.41±1.36	0.082

	MBPS		MBPS (adjusted for age/gender)

	R	p-value	R	p-value
Gender	0.147	0.139
Age	0.011	0.914
Smoking	0.073	0.466	0.102	0.309
Office SBP	0.013	0.894	-0.001	0.995
Office DBP	0.067	0.500	0.103	0.680
24-h SBP	0.140	0.157	0.148	0.139
24-h DBP	0.017	0.865	0.038	0.704
Day-time SBP	0.182	0.066	0.190	0.057
Day-time DBP	0.057	0.568	0.081	0.421
Night-time SBP	0.054	0.585	0.049	0.623
Night-time DBP	-0.087	0.383	-0.081	0.422
LAVI	0.331	0.001	0.340	0.001
IVS	0.155	0.035	0.146	0.048
PW	0.201	0.006	0.201	0.006
LVMI	0.234	0.001	0.232	0.002
E	0.141	0.154	0.129	0.200
A	0.109	0.272	0.102	0.310
DT	0.268	0.006	0.275	0.005
VP	-0.357	<0.001	-0.353	<0.001
E/A ratio	0.026	0.794	0.014	0.887
Em	-0.338	<0.001	-0.328	0.001
Am	0.123	0.215	0.123	0.220
IVRT	0.045	0.652	0.060	0.548
E/Em ratio	0.314	0.001	0.300	0.002
E/VP ratio	0.326	0.001	0.314	0.001
BNP	0.008	0.933	-0.028	0.778

Independent variables	HR	p value	95% CI
Age	1.024	0,082	0,997-1,052
Gender (male)	1.658	0,173	0,802-3,428
MBPS	1.071	0,016	1.013-1.133
Non-dipper BP	2.756	0,010	1.270-5.979
E/Em	1.049	0,022	1.007-1.092

Independent variables	HR	p value	95% CI
Age	1.146	0.014	1.028-1.277
Gender (male)	5.227	0.078	0.831-32.888
MBPS	1.028	0.690	0.898-1.177
Non-dipper BP	1.356	0.639	0.379-4.853
E/Em	0.918	0.039	0.847-0.996
LVEF	0.649	<0.001	0.521-0.809
NYHA FC		0.039
III versus II	3.225	0.112	0.535-19.441
IV versus II	5.252	0.019	1.679-38.861
BNP	1.000	0.917	0.999-1.001

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[TFN1001] ^¥Chi-square test; * Independent t-test. Categorical and continuous data were presented. P<0.05 value that was considered statistically significant. ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; BNP: brain natriuretic peptide; CIHD: chronic ischemic heart disease; CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; DM: diabetes mellitus; HL: hyperlipidemia; NYHA FC: New York Heart Association Functional Class.