Features of the daily blood pressure in patients with ischemic chronic heart failure and renal dysfunction
DOI:
https://doi.org/10.14739/2310-1210.2014.4.27218Keywords:
Heart Failure, Ambulatory Blood Pressure MonitoringAbstract
To date, chronic heart failure (CHF) is one of the most common causes of morbidity and mortality in many countries of the world and in Ukraine. In most part of patients CHF is associated with renal dysfunction. Despite the large clinical and prognostic significance of violations of circadian rhythm of blood pressure in patients with hypertension, the available literature has limited data about the nature of the circadian rhythm of blood pressure in patients with chronic heart failure.
The aim of our study was to investigate the characteristics of daily blood pressure in patients with ischemic chronic heart failure, depending on the level of kidney function.
Materials and methods. The study involved 106 patients with CHF (90 men and 16 women), mean age 56,2±8,8 years. In 35 (33.1%) patients II FC CHF was diagnosed, in 71 (66.9%) - III FC. Daily blood pressure monitoring was performed with the use of CardioTens ("Meditech", Hungary) with registration averages. Variation row of the eGFR was divided into quartiles. Comparative analysis was conducted between CHF patients with eGFR≤70.1 ml/min/1.73 m2 (lower quartile) and CHF patients with eGFR≥86.5 ml/min/1.73 m2 (upper quartile). Statistical analysis was done with statistical software package "Statistica 6.0" (package StatSoft Inc, USA, № license AXXR712D833214FAN5).
Results. Decreased GFR in patients with ischemic heart failure was associated with more senior age (p<0.0001), functional class of heart failure (p=0.02). More common history of hypertension (p=0.04). We found significantly lower left ventricular ejection fraction (p=0.02). There was no difference in the frequency of patients with reduced LVEF (p=0.22). When measuring office blood pressure, arterial hypertension was found in 14 (13.2%) patients with CHF. Ambulatory blood pressure monitoring revealed hypertension in 23 (21.7%) patients of average for SBP and 19 (17.9%) patients for DBP. Arterial hypotension was detected in 5 (4.7%) patients with SBP24 and in 11 (10.4%) patients with DBP24. Insufficient degree of nocturnal decline ("nondipper") SBP was observed in 43 (40.6%), DBP - in 32 (30.2%) patients. Excessive nocturnal decline ("overdipper") SBP was detected in 6 (5.6%), DBP - in 29 (27.4%) patients. Raising a night ("night-picker") SBP was observed in 12 (11.3%), DBP - 5 (4.7%) patients. So certain degree of deviation decrease in nocturnal SBP was detected in 61 (57.5%), DBP - 66 (62.3%) patients. In CHF patients with GFR≤70.1 ml/min/1.73 m2, compared with a group of CHF patients with an eGFR≥86.5 ml/min/1.73 m2 revealed a lower average daily standard deviation of DBP (p=0, 02), the daily index DBP (p=0.05) and the standard deviation of daytime DBP (p=0.05) and night (p=0.03) time. There was a trend toward lower levels of average SBP, DBP, HR, and the standard deviation of SBP and daily index SBP. Analysis of the circadian rhythm in patients with heart failure with a eGFR≤70.1 ml/min/1.73 m2 found that normal circadian index for SBP in 12 (46.2%) patients and in 11 (39.3%) patients with eGFR≥86.5 ml/min/1.73 m2 (χ2=0,84; p=0.36). More pronounced changes were related to daily index DBP, which stipulates that only 7 (26.9%) patients with eGFR≤70,1 ml/min/1.73 m2 and 13 (46.4%) patients with eGFR≥86.5 ml/min/1.73 m2 had normal degree of blood pressure reduction at night (χ2=2,2; p=0.14). Multivariate regression analysis showed that eGFR is associated with age, FC CHF, ejection fraction, blood glucose level, and daily index for SBP and DBP (R2=0,45; p=0.0001).
Conclusion. We found that daily monitoring of blood pressure in patients with ischemic chronic heart can significantly increase detectability hypertension compared with office method (21.7% vs. 13.2%). In patients with ischemic heart failure with GFR≤70,1 ml/min/1.73 m2 certain degree of deviation decrease in nocturnal SBP were detected in 14 (53.8%), DBP - 19 (73.1%) patients. And there were lower rates and the standard deviation of daily index for DBP in both day and at night, and the level of GFR correlated with age, functional class, blood glucose levels and the degree of blood pressure reduction at night.
Further research is perspective prognostic significance of detected violations diurnal blood pressure profile, their pharmacological therapy in patients with ischemic heart failure and renal dysfunction should be evaluated.
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