The prognostic impact of home blood pressure measurements in patients with stage B heart failure

Abstract

Although hypertension is a risk factor for cardiovascular (CVD) events in stage B heart failure (HF), data on the prognostic value of home blood pressure (BP) measurements in stage B HF are limited. We retrospectively analyzed the cases of 568 patients with stage B HF and at least one cardiovascular risk factor who underwent home BP monitoring. Stage B HF was defined as BNP ≥ 35 pg/mL or NT-proBNP ≥125 pg/mL, Troponin T > 0.014 ng/mL, LVEF < 50%, enlarged left ventricular dimensions in diastole (men: ≥60 mm; women: ≥54 mm), enlarged left atrium (men: >40 mm; women: >38 mm), or increased left ventricular mass (men: >115 g/m2; women: >95 g/m2). Office hypertension was defined as systolic BP ≥ 140 mmHg. Home BP was measured in the morning, evening, and nighttime; morning/evening home hypertension was defined as ≥135 mmHg and nighttime home hypertension as ≥120 mmHg. During a mean follow-up of 7.8 ± 3.6 years, 66 CVD events occurred. An unadjusted Cox regression model gave the following hazard ratios (HRs) and 95% confidence intervals (CIs) for CVD-events risk in patients with office, morning, evening, and nighttime home hypertension: HR 1.69 (95% CI 1.03–2.78), 1.73 (1.02–2.95), 1.44 (0.89–2.33) and 2.33 (1.34–4.04), respectively. In a multivariate Cox regression analysis adjusting for significant variables, the association with CVD events remained only for nighttime home hypertension (HR 1.89; 95% CI 1.06–3.38), not other hypertension types. In conclusion, hypertension defined based on nighttime home BP was associated with CVD-events risk in stage B HF patients.