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Lee, J.-.H.1; Hwang, K.1; Lee, S.2; Cho, H.3; Lee, H.3; Choi, J.4; Jeon, E.4; Kim, M.2; Kim, J.2; Chae, S.5; Baek, S.6; Kang, S.7; Choi, D.8; Yoo, B.9; Ahn, Y.10; Kim, K.10; Park, H.11; Oh, B.3; Cho, M.1

doi: 10.1097/01.hjh.0000538998.86458.1a

Objective: The prognostic value of that visit-to-visit blood pressure variability (BPV) has not yet been validated in heart failure (HF) patients.

Design and method: We evaluated the patients hospitalized for acute decompensated HF who registered in the Korean Acute Heart Failure (KorAHF) Registry. Of the 5,627 patients, 900 patients with atrial fibrillation were excluded. The average BP and BPV, as determined by the standard deviation (SD) and coefficient of variation (CV) of systolic and diastolic BP, were recorded at the time of discharge and in outpatient clinic at 3 months, 6 months and 12 months after discharge. The cardiovascular outcome was defined as a composite of death and rehospitalization with aggravated HF.

Results: A total of 3,727 patients (1703 females) were analyzed. Mean age was 67.4 ± 15.3. Average BP was 132.1 ± 31.5/78.1 ± 18.8 mmHg at admission and 115.2 ± 18.2/67.1 ± 11.5 mmHg at discharge. Average BP was 117.0 ± 16.0/68.0 ± 9.3 mmHg and visit-to-visit BPV was 12.6 ± 7.8/8.5 ± 5.2 mmHg by SD and 10.7 ± 6.4/12.6 ± 7.8 % by CV. After a mean follow up duration of 138.3 ± 77.0 days, 250 patients (6.7%) died and 625 patients (16.8%) were rehospitalization with aggravated HF. The patients with clinical event showed significantly lower SBP (114.4 ± 16.8 vs. 117.7 ± 15.7, P < 0.001) and DBP (66.1 ± 9.0 vs. 68.5 ± 9.3, P < 0.001), but systolic BPV (12.4 ± 8.1 vs. 12.6 ± 7.8 by SD, 10.9 ± 6.8 vs. 10.7 ± 6.3 by CV) and diastolic BPV (9.0 ± 5.6 vs. 8.4 ± 5.2 by SD, 13.7 ± 9.2 vs. 12.3 ± 7.3 by CV) were comparable between two groups. In multiple regression analysis, average SBP and DBP was independent predictor of clinical outcomes, but systolic BPV and diastolic BPV did not predict clinical event. In survival analysis, there was also no association between systolic/diastolic BPV and the composite clinical outcomes.

Conclusions: In contrast with other clinical entity, these findings suggest that visit-to-visit BPV is not associated with clinical outcomes in heart failure patients.

1Chungbuk National University Hospital, Cheongju, SOUTH KOREA

2University of Ulsan College of Medicine, Seoul, SOUTH KOREA

3Seoul National University Hospital, Seoul, SOUTH KOREA

4Sungkyunkwan University College of Medicine, Seoul, SOUTH KOREA

5Kyungpook National University College of Medicine, Daegu, SOUTH KOREA

6The Catholic University of Korea, Seoul, SOUTH KOREA

7Yonsei University College of Medicine, Seoul, SOUTH KOREA

8Seoul National University Bundang Hospital, Seongnam, SOUTH KOREA

9Yonsei University Wonju College of Medicine, Wonju, SOUTH KOREA

10Heart Research Center of Chonnam National University, Gwangju, SOUTH KOREA

11National Institute of Health (NIH), Osong, SOUTH KOREA

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