Determinants and Clinical Impact of Visit-to-visit Blood Pressure Variability in Patients with Heart Failure with Preserved Ejection Fraction.

Introduction: Blood pressure (BP) affects the prognosis of patients with heart failure with preserved ejection fraction (HFpEF). However, the implications of its variability are poorly understood. This study aimed to explore the determinants and prognostic significance of visit-to-visit BP variability (V2V-BPV) in HFpEF.

Methods: Consecutive patients with HFpEF at the Sakakibara Heart Institute of Okayama underwent routine BP measurements. V2V-BPV, calculated as the coefficient of variation of systolic BP over one year, was assessed. The primary endpoint comprised all-cause mortality and heart failure hospitalization.

Results: Among 288 outpatients with HFpEF (average age 73 ± 10 years, 60.8% male), BP was measured 6.1 ± 1.7 times, with a median V2V-BPV of 7.3%. The high V2V-BPV group (≥7.3%) had marginally but significantly elevated B-type natriuretic peptide (BNP) levels and higher Meta-Analysis Global Group In Chronic Heart Failure risk scores (MAGGIC scores). V2V-BPV was independently associated with an increased risk of the primary endpoints (hazard ratio 1.08 per percentage point; p = 0.025), even after adjustments for systolic BP, BNP, MAGGIC score, and the number of BP measurements. A similar relationship was observed between all-cause mortality and V2V-BPV (adjusted hazard ratio 1.12, p = 0.049 with MAGGIC score). Hemoglobin level was an independent predictor of high V2V-BPV in multiple sensitivity analyses.

Conclusions: In patients with HFpEF, V2V-BPV was independently associated with adverse events, with hemoglobin level emerging as a determinant. Further research is warranted to determine whether BP stabilization can improve the prognosis of HFpEF.