BLOOD PRESSURE VARIABILITY AS A PREDICTOR OF MAJOR CARDIOVASCULAR EVENTS IN PATIENTS STABILIZED AFTER ACUTE HEART FAILURE

초록

Background: Blood pressure variability (BPV) has been linked to adverse cardiovascular outcomes, including heart failure and mortality, in various populations. However, the impact of BPV on patients stabilized for one year post-acute heart failure hospitalization remains underexplored. Methods: This multicenter retrospective cohort study used electronic health records of patients admitted for acute HF between January 1, 2017, and June 30, 2021. Blood pressure was measured 3 to 12 times during the first year post-discharge (BP monitoring phase). Patients re-admitted for MI, stroke, or HF during this phase, or lost to follow-up, were excluded. The primary outcome was the incidence of MACE— cardiovascular death, new-onset MI, stroke, and HF re-hospitalization—from one year post-discharge to June 30, 2024 (MACE monitoring phase). Results: A total of 1,818 patients were included. Receiver operating characteristic curve analysis for MACE showed similar area under the curve (AUC) values for BPV calculated using coefficient of variation (CV), standard deviation (SD), variability independent of the mean (VIM), and average real variability (ARV): 0.55 for CV, 0.53 for SD and ARV, and 0.57 for VIM. Patients were categorized into high and low CV groups based on the median CV value (12.36). The high CV group, characterized by older age, higher prevalence of comorbidities, and female predominance, had a significantly higher incidence of MACE compared to the low CV group, primarily driven by HF rehospitalization (24.2% vs. 18.5% for MACE, p < 0.01; 20.7% vs. 14.6% for HF re-hospitalization, p < 0.01). Multivariable analysis identified high CV group, age, male sex, diabetes mellitus, chronic kidney disease, prior HF, prior stroke, and ischemic HF as independent predictors for MACE (hazard ratio [HR] 1.27; 95% confidence interval [CI], 1.03-1.57 for high CV group). Conclusion: BPV is a significant predictor of adverse cardiovascular outcomes, particularly HF re-hospitalization, even among patients stabilized for one year following an acute HF hospitalization. Targeted management of BPV may reduce long-term cardiovascular risk in this population.