Importance of Anemia in Heart Failure over Blood Pressure Variability

Abstract The evaluation of arteriosclerosis (vascular function) is important when treating heart failure (HF). Vascular dysfunction is associated with anemia through renal function and endothelial nitric oxide synthase, and many patients with HF have anemia. Additionally, blood pressure variability (BPV) caused by vascular dysfunction is also associated with HF prognosis. However, how anemia and BPV may affect HF prognosis is unclear. Between January 2012 and July 2018, 214 patients with HF were hospitalized, the cardio-ankle vascular index (CAVI) as an index of arteriosclerosis of whom was measured. According to the CAVI, the patients were divided into the elevated and preserved CAVI groups. Furthermore, we investigated the factors related to major adverse cardiovascular events (MACE). MACE was defined as cardiovascular death or rehospitalization within 1 year after discharge. In the elevated CAVI group, significant differences in body mass index (BMI), BPV, left ventricular dimension, and hemoglobin levels were observed between patients with MACE and those without MACE. Meanwhile, in the preserved CAVI group, significant differences in BMI, diastolic/mean blood pressure values, and hemoglobin levels were observed. The multivariate analysis showed an independent association between hemoglobin level and MACE occurrence in both the elevated and preserved CAVI groups (elevated CAVI group: hazard ratio [HR] = 0.800, P = 0.045; preserved CAVI group: HR = 0.783, P = 0.049 {model 1}, and HR = 0.752, P = 0.023 {model 2}). Anemia was independently associated with HF prognosis with or without arteriosclerosis. In HF with arteriosclerosis, BPV may also be useful for evaluating the prognosis.