Association of home blood pressure with asymptomatic Stage B heart failure determined by cardiac biomarkers

Abstract

Heart failure (HF) guidelines recommend screening for non-symptomatic Stage B HF. Evidence on the utility of home blood pressure (BP) for risk stratification of Stage B HF is limited. We aimed to examine the association of home BP with the prevalence of Stage B HF and the risk of symptomatic HF. This study used cohort data with 14 days of morning and evening home BP measurements, biomarker sampling, and cardiovascular event follow-up among Japanese outpatients. Stage B HF was defined as N-terminal pro-B-type natriuretic peptide ≥125 pg/mL, and/or high-sensitivity cardiac troponin >22 ng/L in men and >14 ng/L in women. Among 3077 participants without prior cardiovascular disease including coronary artery disease, symptomatic HF, stroke, and others (mean age 64.5 years, 43.1% male), 548 participants had Stage B HF. In the multivariable logistic model, home systolic BP (SBP) was associated with Stage B HF (OR [95% CI] per 10 mmHg, 1.22 [1.13–1.33]). The area under the curve (AUC) was significantly improved by adding home SBP to the model including office SBP (AUC 0.757–0.763). During the median 5.0-year follow-up, Stage B HF was associated with a higher risk of HF hospitalization (adjusted HR [95% CI], 3.94 [1.45–10.70]). Home SBP tended to be associated with an increased risk of HF hospitalization (unadjusted HR [95% CI] per 10 mmHg, 1.29 [0.97–1.71], p = 0.081), but this association was not significant after adjustment. In conclusion, appropriate BP management using home BP monitoring before the progression of HF could help prevent symptomatic HF.