Prognostic Value of Ambulatory Blood Pressure Monitoring in Patients Admitted With Acute Decompensated Heart Failure: A Prospective Observational Study From a Tertiary Referral Centre.
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Abstract
Background and objectives: Heart failure (HF) remains a major cause of morbidity and frequent readmissions in India. Ambulatory blood pressure monitoring (ABPM) offers dynamic evaluation of blood pressure (BP) patterns, BP variability and morning blood pressure surge (MBPS) which may provide prognostic value in patients with acute decompensated heart failure (ADHF).
Methods: A prospective observational study enrolling 300 patients admitted with ADHF. After stabilization and prior to discharge, all patients underwent ABPM and were categorized based on dipper patterns. Clinical outcomes, including mortality and re-hospitalization at 3 months, were assessed. Survival analyses were performed using Kaplan-Meier curves and multivariable Cox regression.
Results: The mean age of the cohort was 60.2 years; 68% were male. Most patients had HF with reduced ejection fraction (84%), and 57% were hypertensive. Dipper patterns were distributed: normal dipper 51%, non-dipper 36%, reverse dipper 11%, and extreme dipper 2%. At 3 months, mortality was 5.3% and re-hospitalization in 44% of patients. Kaplan-Meier analysis revealed increased mortality in reverse dippers, highest average real variability percentile, and low/high MBPS groups (p<0.0001). Multivariable Cox regression identified extreme dipper (hazard ratio [HR], 9.28; 95% confidence interval [CI], 1.85-46.49; p=0.007), reverse dipper (HR, 7.53; 95% CI, 2.47-22.10; p=0.01), low systolic BP (HR, 3.70; 95% CI, 1.22-11.22; p=0.02) associated to mortality.
Conclusions: ABPM is a practical tool for risk stratification in HF. Abnormal nocturnal BP dipper patterns and increased BP variability were associated with increased adverse short-term outcomes in ADHF. Discharge ABPM may aid early risk stratification, while other circadian BP abnormalities primarily reflect disease severity rather than independent risk.
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