MPS 09-04 CENTRAL SYSTOLIC BLOOD PRESSURE IS NO LONGER MARKER OF ARTERIAL STIFFNESS IN PATIENTS WITH ARTERIAL HYPERTENSION AND HEART FAILURE WITH REDUCED EJECTION FRACTION

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Abstract

Objective:

The aim of the study was to assess arterial stiffness and its diagnostic and prognostic value in patients with arterial hypertension (AH) and heart failure with reduced ejection fraction (HFrEF).

Design and Method:

In 93 stable patients (75% male, age 64 ± 9 years (M ± SD), history of myocardial infarction 67%, diabetes mellitus 32%, blood pressure (BP) 131 ± 14/80 ± 10 mmHg with AH, symptoms and signs of HF, LV EF <40% and NT-proBNP >100 pg/ml applanation tonometry and 2-dimentional echocardiography were performed. Mann-Whitney and Spearman tests were considered significant if p < 0.05.

Results:

Patients with NYHA III compared with patients NYHA II class had lower central systolic (118 ± 12 vs 134 ± 10 mmHg, p < 0.001), diastolic (82 ± 10 vs 87 ± 15 mmHg, p < 0.05) and pulse BP (36 ± 7 vs 46 ± 6 mmHg, p < 0.001), time to reflected wave (Tr) (131 ± 15 vs 145 ± 21 ms, p < 0.05), higher augmentation index (AI) (26 ± 7 vs 16 ± 8%, p < 0.001), carotid-femoral pulse wave velocity (PWV) (13.5 ± 4.1 vs 9.2 ± 1.5 m/s, p < 0.001). Central systolic and pulse BP positively correlated with EF and paradoxically negatively correlated with PWV. In prospective study AI ≥25, Tr < 135 ms were associated with adverse outcomes. PWV ≥15 m/s increased risk of HF hospitalizations. AI ≥35%, Tr <116 ms increased risk of all-cause death.

Conclusions:

In patients with AH and HFrEF dissociation between central systolic and pulse BP and arterial stiffness markers was revealed. Patients with more severe HF/ poor prognosis had lower systolic and pulse PP but higher PVW and AI. In this population central systolic and pulse BP were more dependent on LV systolic function and were no longer markers of aortic elasticity.

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