DISCREPANCY BETWEEN STANDARD AND SELF-MONITORED BLOOD PRESSURE VALUES IN PATIENTS HOSPITALIZED WITH DECOMPENSATED HEART FAILURE.

Objective: The level of blood pressure (BP) in patients with decompensated heart failure (DHF) is of key importance in therapy selection and titration. The recommended measurement of standard BP in the morning before taking medications is rarely performed in routine standard practice and BP values in the medical history may not reflect real BP control. To compare the results of standard BP measurement made by physician and self-monitoring of morning and evening BP (SMBP) performed according to the rules of BP measurement in patients hospitalized with DHF. Design and method: Patients with DHF measured their BP with an automatic tonometer three times in the morning and evening before taking medications with a 1-minute interval for 7 days. If self-monitoring was impossible, the procedure was performed by a physician-researcher. Standard BP values were taken from the records in the medical history, the measurement time was not regulated, and the measurement was made once. Lack of hypertension (HTN) control was defined as standard BP>=140/90 mmHg and BP during self-monitoring>=135/85 mmHg; hypotension was defined as SBP<=90 mmHg. The results were considered reliable at p<0,05. Results: 50 patients were included (men 61%, 69.6±10 years, HTN history 100%, previous MI 33.3%, AF 47.9%, quadruple therapy in 40%, triple therapy in 60%, HFrEF 37%, HFrEF 13%, HFpEF 50%; median EF 51%(IQR38;55%), NTproBNP 623(500;1842) pg/ml, standard BP 121.5±12/68.7±7 mmHg; by self-monitoring 119.2±19/71.3±10 mmHg (p<0.001 compared to standard). Normotension by SMBP and standard measurement was observed in 67% and 95%; uncontrolled BP in 28% and 5%; hypotension - in 5% and 0% (p<0.001 compared to standard) respectively. In a similar analysis in three LVEF subgroups, the frequency of normo-, hyper- and hypotension during self-monitoring was 31%,10%,0% for HFrEF, 8%,5%,0% for HFrEF, and 28%,13%,5% for HFpEF, respectively; during standard measurement in HFrEF normotension in 100%, in HFmrEF 10%,4% and 0%, in HFpEF 46%,1%,0%respectively (Table 1).Conclusions: In patients with DHF, guideline recommended self-monitoring of BP gives more accurate results than routine BP measurement made by physician and should be taken into consideration for better antihypertensive drugs titration.