The Value Of Ambulatory Blood Pressure Monitoring In Severity Evaluation And Prognostic Judgement Of The Patients With Congestive Heart Failure

Objectives:1.To observe the day-night blood pressure rhythm of the patients with congestive heart failure(CHF).2.To research the value of ambulatory blood pressure monitoring(ABPM)for severity evaluation of patients with CHF.3.To explore the prognostic value of ABPM for patients with CHF.Methods:1. A total of 92 inpatients with CHF were enrolled into this study, all experienced 24h ambulatory blood pressure monitoring and were divided into different groups by the basic heart disease and New York Heart Association (NYHA) functional class. Selected 72 inpatients and outpatients with the basic heart disease but no CHF during the same period as control group. Observe the day-night blood pressure rhythm of the patients with CHF and investigate the relationship between the day-night blood pressure rhythm and etiology of CHF and NYHA class. Explore the relationship between the parameters of ABPM and the NYHA class of CHF.2. All patients were followed up at least 3 months, and death was settled as primary ending point. Compare the ambulatory blood pressure parameters between survival group and dead group.The CHF patients were divided into different groups according the level of blood pressure and drew survival curve.Prognostic factors such as NYHA class,left ventricular ejection fraction(LVEF),ambulatory blood pressure parameters were selected for univariate and multivariate Cox proportional hazards model analysis, and explored the prognostic value of ambulatory blood pressure monitoring for patients with CHF.Results:1 Day-night blood pressure rhythm in non-dilated cardiomyopathy(NDCM) heart failure group: 12(16.0%) normal, 63(84.0%) vanished including30(47.6%) inversed; accordingly, 35(48.6%) normal, 37(51.4%) vanished including 8(21.6%) inversed in control group.The incidence of vanished and inversed blood pressure rhythm in NDCM heart failure was obveriously higher than that in control group(P<0.05).In the heart failure group by etiology day-night blood pressure rhythm disappearance:DCM 15(88.2%), hypertension heart disease(HHD) 24(82.8%), coronary heart disease(CHD) 20(83.3%) and HHD with CHD 19(86.4%); day-night blood pressure rhythm inversion: DCM 7(46.7%), HHD 12(50.0%), HHD with CHD 11(57.9%) and CHD 7(35.0%), there were no significant differences among them(P>0.05). In the heart failure group by NYHA class, day-night blood pressure rhythm disappearance:II 21(70.0%),III nd IV 57(91.9%),The ratio of disappeared circadian rhythm in NYHA III and IV was higher than NYHA II(P<0.01).day-night blood pressure rhythm inversion: II 9(42.9%),III and IV28(49.1%),there was no difference in two groups(P>0.05).2 The day systolic blood pressure(DSBP),day diastolic blood pressure(DDBP),24-hour mean blood pressure(24hMBP),day mean blood pressure(DMBP),day pulse pressure(DPP),day diastolic blood pressure variability(DDBPV) of NDCM group were significantly lower than those of control group(P<0.05 and 0.01),and the SBP,MBP,PP during 24h ,daytime,and nighttime and DDBP of NYHA IV were significantly lower than those of NYHA II and III(P<0.05 and 0.01).24hSBP,24hDBP,24hMBP,24h SBPV and NYHA class presented obveriously negative correlation(P<0.05 and 0.01).3 After a period of at least 3 months,there were 17 CHF patients deaths,including 7 DCM,3 HHD,2 CHD and 5 HHD with CHD patients. SBP,MBP and PP of 24h,daytime and nighttime of dead group were all significantly lower than those of survival group.Kaplan-Meier and log-rank tests of nonparametric analysis revealed that patients with 24hSBP≥105mmHg,24hMBP≥80mmHg and 24hPP≥35mmHg had longer survival.Univariate Cox analysis showed that NYHA IV,DCM,24hSBP<105mmHg,24hMBP<80mmHg and 24hPP<35mmHg were predictive factors for cardiac death;multivariate Cox analysis showed that the independent predictors for cardiac death in patients with CHF were NYHA IV and 24hSBP<105mmHg.Conclusions:1. Day-night rhythm of blood pressure with CHF were mostly disappeared and inveresed.These changes were positively correlated with the degree of CHF and had no correlation with etiology of CHF.2. DSBP,DDBP,24hMBP,DMBP,DPP and DDBPV in CHF were significantly lower than those in control group.Blood pressure decreased with the severity of CHF. SBP,MBP and PP of 24h,daytime and nighttime and DDBP of NYHA IV were lower than those of NYHA II and III.3. Mortality increased in CHF with low blood pressure. SBP,MBP,PP are important prognostic factors. 24 SBP <105mmHg is a independent predictor of mortality.