Author + information
- Ercan Taştan1,
- Hasan Murat Uğurlu1,
- Mehmet Han Mercen1,
- İlyas Kaya1,
- Mehmet Zihni Bilik3 and
- Mehmet Serdar Soydinç2
Heart failure is a chronic progression characterized by neuroendocrine system maladaptation. This chronic progressive situation reflects an increase in sympathetic activity and peripheral vascular resistance and a decrease in baroreceptor sensitivity, and could be the cause of changes in the diurnal rhythm of blood pressure. However, some trials show that the circadian rhythm of blood pressure in patients with severe systolic heart failure does not differ from that of control groups. In contrast, trials generally show that nondipper and reverse dipper patients more frequently experience severe heart failure. No trials have examined the effects of heart failure etiology for this situation. Our purpose is to determine the circadian rhythm differences between ischemic and nonischemic cardiomyopathy patients.
Our study included 66 patients: 22 with ischemic cardiomyopathy, 22 with nonischemic cardiomyopathy, and 22 as a control group. The ejection fraction was under 40% with sinus rhythm, and the left heart was enlarged, with no biventricular pace implantation, no severe heart valve disease; no patient was receiving dialysis. All patients underwent hemograms and routine laboratory tests and their BMIs and GFRs were calculated. Echocardiographic tests were conducted on all patients and each patient took a 24 hour ambulatory blood pressure device and prepared for the study.
The ischemic cardiomyopathy group (21M, 1F) had a statistically significant higher male patient ratio than the nonischemic cardiomyopathy group (14M, 8F) and the control group (13M, 9F). A statistically high statin use also occurred in the ischemic cardiomyopathy group compared to the nonischemic cardiomyopathy group. No significant differences existed between the ischemic and nonischemic cardiomyopathy patients for ejection fraction, age, DM, HT, glomerular filtration rate, body mass index, hemogram, and routine laboratory tests. In control group dippers, in nonischemic cardiomyopathy group nondippers, and in ischemic cardiomyopathy group, the number of reverse dippers was statistically high (p<0.001).
This study showed that the diurnal rhythm of blood pressure changes in severe systolic heart failure. In the nonischemic cardiomyopathy group, 54% of the patients were nondippers and 27.3% were reverse dippers. In the ischemic cardiomyopathy group, 63.6% of the patients were reverse dippers and 27.3% were nondippers. When we combined the findings of our study, the ischemic cardiomyopathy group had a higher future mortality and hospitalization than the nonischemic cardiomyopathy group because the number of reverse dippers was significantly higher in this group. This emphasizes the importance of ambulatory blood pressure monitoring and evaluation of the nondipper situation in the prognosis of congestive heart failure in these patients. Ambulatory blood pressure monitoring has an important role in determining the drug taking hours.