Background:Rising blood pressure (BP) in the morning, known as the morning BP surge (MBPS), is known to pose a risk for cardiovascular events in hypertensive individuals. It was not known whether the MBPS was associated with a worse prognosis in patients with heart failure (HF) with a reduced (HFrEF) or preserved (HFpEF) ejection fraction.

Methods and Results:We performed a prospective, observational cohort study of hospitalized HF patients who underwent ambulatory BP monitoring (ABPM). The MBPS was calculated by subtracting the mean systolic BP (SBP) during the 1 h that included the lowest sleep BP from the mean SBP during the 2 h after waking. The MBPS group was defined as the top decile of MBPS (>40 mmHg). In all, 456 hospitalized HF patients (mean [±SD] age 68±13 years, 63.9% male) were followed-up for a median of 1.67 years. There were 90 events (16.3 per 100 person-years) of the composite outcome (all-cause mortality and worsening HF) in the HFrEF group, compared with 53 events (19.6 per 100 person-years) in the HFpEF group. Multivariate Cox regression analysis showed that MBPS was a significant predictor of outcome (hazard ratio 2.84, 95% confidence interval 1.58–5.10, P<0.01) in the HFrEF but not HFpEF group.

Conclusions:MBPS was found to be a novel predictor of worsening HF in patients with HFrEF.

背景：众所周知，早晨血压 (BP) 升高，称为晨间血压激增 (MBPS)，会导致高血压个体发生心血管事件。尚不清楚 MBPS 是否与射血分数降低 (HFrEF) 或保留 (HFpEF) 的心力衰竭 (HF) 患者的预后较差有关。

方法和结果：我们对接受动态血压监测 (ABPM) 的住院 HF 患者进行了一项前瞻性观察性队列研究。MBPS 的计算方法是从醒来后 2 小时的平均 SBP 中减去包括最低睡眠 BP 在内的 1 小时内的平均收缩压 (SBP)。MBPS 组被定义为 MBPS 的最高十分位数 (>40 mmHg)。总共对 456 名住院 HF 患者（平均 [±SD] 年龄 68±13 岁，63.9% 男性）进行了中位随访 1.67 年。HFrEF 组有 90 起事件（16.3/100 人年）复合结局（全因死亡率和 HF 恶化），而 HFpEF 组有 53 起事件（19.6/100 人年）。多变量 Cox 回归分析表明，MBPS 是结果的显着预测因子（风险比 2.84，95% 置信区间 1.58-5.10，P<0.

结论： MBPS 被发现是 HFrEF 患者 HF 恶化的新预测因子。