Systolic blood pressure amplification predicts death and heart failure hospitalization in heart failure with reduced ejection fraction
T Weber, K Danninger, N Schwegel, K Ablasser, E Kolesnik, N Verheyen, S Orter, B Hametner, C C Meyer, S Wassertheurer, R K BinderAbstract
Background
Systolic blood pressure (SBP) physiologically increases from the aorta to the brachial artery (amplification - SBPAmp), and is determined by age, sex, heart rate, arterial properties and systolic function.
Purpose
To investigate the prognostic role of SBPAmp in patients with heart failure (HF) with reduced ejection fraction (HFrEF).
Methods
Office brachial SBP (bSBP) was measured with a validated device, and central SBP (cSBP) was determined, using radial tonometry and a validated transfer function. SBPAmp was calculated as ((bSBP-cSBP)/bSBP)*100. HFrEF patients were treated and followed in 2 specialized heart failure clinics, according to HF guidelines. Cox proportional hazards models included SBPAmp, age, sex, ejection fraction (EF), bSBP, heart rate, center, log Nt-proBNP, diabetes, coronary artery disease, medications, and filling pressures (E/E´).
Results
Overall, 232 patients (mean age 63.2 years, 17.6% women) were included. 23.4% had diabetes, 60.3% coronary artery disease and 24.7% a prior myocardial infarction. Mean ejection fraction (EF) was 32.9%, mean Nt-proBNP 2801 pg/ml, mean brachial blood pressure was 124/78 mmHg. During an average follow up of 3.5 years, 80 patients died, and 54 were hospitalized for HF. In fully adjusted Cox models, a higher SBPAmp was an independent predictor of all cause mortality (Table) and of the combined endpoint death and HF hospitalization (HR 1.12, CI 1.03-1.21, p=0.006).
Conclusion
SBPAmp is a novel independent prognostic marker in HFrEF, reflecting the role of arterial properties.TableFor image description, please refer to the figure legend and surrounding text.