Abstract

Introduction: Intensive blood pressure (BP) lowering therapy is associated with lower rates of major adverse cardiac and cerebrovascular events in the general population. On the other hand, lower daytime systolic BP (SBP) is associated with higher mortality in patients with heart failure (HF). However, prognostic impact of SBP during sleep was unclear in patients with HF. Methods and Results: We measured continuous SBP during sleep non-invasively by pulse transit time in 379 patients with HF (median age 71, male 53.6%). Beat-to-beat SBP was calculated based on pulse transit time, which was defined as the travel time from the R-wave of electrocardiogram to the pulse wave at the finger detected by plethysmography. Mean values of SBP during sleep were used in the present study. The primary endpoint was hospitalization for worsening HF. The patients were divided into three groups based on the tertiles of SBP during sleep: High SBP group (median SBP 138 mmHg, n = 127), Middle SBP group (median SBP 117 mmHg, n = 127), and Low SBP group (median SBP 100 mmHg, n = 125). The Low SBP group showed the youngest age (High, Middle, and Low groups; 73, 73, 68 years, P < 0.001). Levels of B-type natriuretic peptide (207.7, 216.7, and 407.2 pg/mL, P = 0.039) and estimated glomerular filtration rate (52.6, 54.0, and 57.1 mL/min/1.73 m 2 , P = 0.041) were the highest in the Low SBP group. During the follow-up period of median 1,083 days after SBP measurement, 66 patients experienced hospitalization for worsening HF. Kaplan-Meier analysis revealed that primary endpoint occurred most frequently in the Low SBP group ( Figure ). Multivariable Cox proportional hazard analysis showed that the lowest SBP tertile was associated with the primary endpoint compared to the highest SBP tertile (hazard ratio 2.546, 95% confidence interval 1.257–5.158, P = 0.009). Conclusion: Low SBP during sleep was associated with hospitalization for HF in patients with HF.