Heartbeat Trust

IntroductionThe presence of abnormal nocturnal blood pressure (BP) patterns has been associated with adverse cardiovascular events such as heart failure and ischemic heart disease. We performed a sub-analysis of the PARABLE trial (NCT04687111) consisting of patients at risk of developing heart failure. Our aim was to investigate whether the presence of nocturnal hypertension (NH) and a ‘riser pattern’ was associated with increased NT-proBNP levels, as a marker of cardiac end-organ damage in comparison to other BP patterns. This is one of the largest studies correlating NT-proBNP levels with the presence of a riser pattern in otherwise well treated patients with normal daytime BP.MethodologyBaseline demographic data, ambulatory BP monitor results and NT-proBNP levels were available for 246 of the 250 PARABLE trial patients, which included those with hypertension or diabetes, an elevated BNP or NT-proBNP and an abnormal LAVI>28 mL/m2. These were analysed by means of independent-samples t-test or Matt-Whitney test for continuous variables and chi-square or Fisher exact tests for categorical variables. Statistical analysis was performed using SPSS v27.ResultsTable 1 and 2 summarises the baseline clinical data. The study cohort had a mean age of 71.9±7.7 years and 93 patients (37.8%) were female. 144 patients (58.5%) had NH as defined by the ESC whereas 102 patients (41.5%) had normal night-time BP. Nocturnal BP analysis revealed 77 dippers, 12 extreme dippers, 127 non-dippers and 30 risers. Baseline demographics did not defer between the various dipping sub-groups. However, risers had a significantly higher mean 24-hour systolic BP (133±11 vs 128±11mmHg, p=0.016). This was driven by higher nocturnal BP as expected (138±13 vs 120±12mmHg, p<0.0001) but with similar day-time systolic BP (130±10 vs 132±12mmHg, p=0.368). BNP Data The median NT-proBNP of NH patients was higher compared to normotensive patients (158pg/mL (IQR: 96-293) vs123 pg/mL (IQR: 75-210); p= 0.001). However, NH patients tended to have higher daytime systolic BP (137±10 vs 125±10 mmHg; p<0.001) and rates of atrial fibrillation (13.2% vs 4.9% ; p= 0.031) compared to those with normal nocturnal BP, which could have confounded the analysis. There was a significant difference in median NT-proBNP across all dipping groups (p=0.043). Risers had the highest plasma NT-proBNP in comparison to other dipping groups combined:198pg/mL (IQR: 119-198) vs 135 pg/mL (IQR: 82.25-234.75) (p=0.02). (See figure 1). 44 Table 1Baseline data and co-morbidities (n= 246)Age (years) 71.9 ± 7.7 Male (%) 62.2% Diabetes mellitus – No (%) 59 ( 23.9%) Dyslipidaemia – No (%) 218 (88.6%) Coronary artery disease – No (%) 104 (42.2%) Atrial fibrillation – No (%) 24 (9.8%) Chronic kidney disease – No (%) 46 (18.6%) Established arterial hypertension – No (%) 241 (97.9%) Nocturnal Hypertension 144 patients 44 Table 2Baseline characteristics of risers and non-risers Riser pattern(N = 30) Non-riser patterns (dippers, extreme dippers and non-dippers)(N=216) P value Age (years) 72±7.68 71.83±7.68 0.909 LVEF –% 65±7.67% 67.2±6.87% 0.107 Mean 24 hour systolic BP -mmHg 133±11 128±11 0.016 Mean daytime systolic BP – mmHg 130±10 132±12 0.368 Mean nocturnal systolic BP – mmHg 138±13 120±12 <0.0001 Female sex – No (%) 12/30 (40%) 81/216 (37.5%) 0.791 Diabetes mellitus – No (%) 8/30 (26.7%) 51/216 (23.6%) 0.713 Coronary artery disease – No (%) 13/30 (43.3%) 91/216 (42.1%) 0.900 Atrial fibrillation – No (%) 3/30 (10%) 21/216 (9.72%) 1.000 Chronic kidney disease – No (%) 2/30 (6.67%) 44/216 (20.37%) 0.082 ACE inhibitor use 11/30 (36.67%) 85/216 (39.35%) 0.778 ARB use 11/30 (36.67%) 87/216 (40.28%) 0.705 CCB use 10/30 (33.33%) 97/216 (44.91%) 0.231 Thiazide use 9/30 (30%) 64/216 (29.63%) 0.967 Loop diuretic use 2/30 (6.67%) 10/216 (4.63%) 0.645 44 Figure 1NT-proBNP data across dipping groupsConclusionPatients with NH had higher plasma NT-proBNP levels than those without nocturnal hypertension. Risers had the highest NT-proBNP data and therefore may be at increased risk of heart failure compared to other subgroups. This study provides evidence that nocturnal hypertension and abnormal dipping, pattern is associated with adverse cardiac physiological changes. This observation lends support for initiating the use of 24hour-ABPM to identify those with subclinical target organ damage for risk stratification and individualized treatment strategies.

332 Elevated B-type natriuretic peptide is associated with the presence of diastolic abnormalities in an asymptomatic, at-risk community population: The Screening TO Prevent Heart Failure (STOP HF) Study C. Conlon1, C. O’Loughlin1, A. Patle1, K. Kinch1, A. Whelan1, C. Kelleher2, M. Ledwidge1, K. Mcdonald1 on behalf of the STOP HF Investigators 1St Vincent’s University Hospital, The Heartbeat Trust, Heart Failure Research, Dublin, Ireland; 2University College Dublin, Public Health and Population Science, Dublin, Ireland