Ambulatory Blood Pressure Parameters and Heart Failure With Reduced or Preserved Ejection Fraction in Elderly Treated Hypertensive Patients

Background: The association between ambulatory blood pressure (BP) and future risk of heart failure (HF) is unclear. We investigated the association between ambulatory BP parameters and risk of HF with reduced ejection fraction (HFREF) or preserved ejection fraction (HFPEF) in elderly treated hypertensive patients. Methods: The occurrence of HFREF and HFPEF was evaluated in 1191 elderly treated hypertensive patients who underwent clinical and instrumental evaluation, including ambulatory BP monitoring to evaluate, daytime, nighttime, and 24-hour BP, dipping status and morning surge (MS) of BP. Results: During the follow-up (9.1  4.9 years, range 0.4-20 years), 123 patients developed HF, of whom 56 had HFREF and 67 had HFPEF. After adjustment for other covariates, Cox regression analysis showed that 24-hour systolic BP, but not clinic BP, was independently associated with risk of both HFREF (hazard ratio (HR) 1.36, 95% confidence interval (CI) 1.14-1.63, per 10 mmHg increment) and HFPEF (HR 1.35, 95% CI 1.13-1.61, per 10 mmHg increment); moreover, high MS of BP (> 23 mmHg) in dippers was independently associated with risk of HFREF (HR 2.27, 95% CI 1.00-5.15) and nondipping was independently associated with risk of HFPEF (HR 2.78, 95% CI 1.38-5.63). Conclusions: In elderly treated hypertensive patients, 24-hour systolic BP is independently associated with future risk of both HFREF and HFPEF, whereas high MS is independently associated with risk of HFREF and nondipping is independently associated with risk of HFPEF.