Ambulatory Blood Pressure Monitoring in Chronic Congestive Heart Failure in Normotensive and in Sinus Rhythm Patients with Ischemic Heart Disease

Objectives: The objective of this study is to analyse the blood pressure behaviour, before and after compensation by medical treatment of decompensated chronic congestive heart failure, in normotensive and in sinus rhythm patients with ischemic heart disease. Its main purpose is to find out whether heart failure compensation is associated with still normal blood pressures or, on the contrary, with the risk of an arterial hypotension.
Methods: Data recorded by 24 hours ambulatory blood pressure monitoring, before and after an efficient compensation of heart failure in 16 patients (13 males and 3 females) with decompensated chronic congestive heart disease secondary to ischemic heart disease in functional NYHA classes III (5 patients) or IV (11 patients) were analysed and compared.
Results: In the decompensated state, mean systolic blood pressure per 24 h was normal, but well below the superior limit accepted as normal. Significant decreases of all systolic and diastolic blood pressures, per 24 h, diurnal and nocturnal, close to or even in the domain of arterial hypotension, were recorded after the efficient compensatory treatment. None of the patients had clinical symptoms of arterial hypotension. Significant prevalence of the non-dipper state, high in the decompensated state and still present after the efficient heart failure compensation, was found. A significant decrease of the heart rate after heart failure compensation was observed. Decompensated state was associated mainly with heart rates above 70/min, while the compensated state was associated mainly with heart rates below 70/min.
Conclusions: Significant asymptomatic decrease of the blood pressure, with a tendency towards arterial hypotension, is revealed by ambulatory blood pressure monitoring, after the efficient treatment of the decompensated chronic congestive heart failure, in normotensive and in sinus rhythm patients with ischemic heart disease. This blood pressure decrease could add a supplementary cardiovascular risk. A high prevalence of the non-dipper state, with its negative significance, was found especially in the decompensated, but also in the compensated state of the chronic congestive heart failure.