Ambulatory Blood Pressure in HFPEF Outcomes Global Registry

Heart failure and preserved ejection fraction (HFPEF) is a disease with increasing prevalence world wide. Due to its etiological and prognostic relationship with hypertension, it is highly interesting to know the characteristics and influence of Blood pressure levels and of the hemodynamic biomarkers, measured by Ambulatory Blood Pressure measurement in the outcome of patients with (HF-PEF), defined by the risk of cardiovascular morbidity and mortality (hospital re-admissions, emergency room visits, functional decline and mortality). The investigators consider other factors such as Frailty, comorbidities, and the baseline functional capacity to asses the prognostic value.

The prognosis of patients with heart failure and preserved ejection fraction (HF-PEF), defined by the risk of cardiovascular morbidity and mortality (hospital re-admissions, emergency room visits, functional decline and mortality), depends on multiple factors such as Frailty, comorbidities, BP values, hemodynamic parameters and the baseline functional capacity. Correct definition of these prognostic factors may help define more effective management strategies This is a Prospective observational cohort study, aimed to identify prognostic factors of readmission for heart failure or death in patients with HF-PEF.

Patients with stable HF-PEF will be included monitoring will be by telephone or personal interview every 3 months for at least one year.Specific data on HF will be collected directly from the patient, or from the computerized medical record, with the objective of determining different aspects of HF.

An echocardiogram performed 6 months before inclusion in the case of known HF, or up to 3 months after inclusion, will be considered valid. Parameters collected will include ejection fraction, dimensions of the atrium and ventricle and variables of diastolic dysfunction. ( The procedures for BP measurement, will be according to the ESH/ESC 2018 guidelines, All patients included in the study should have a 12 lead rest EKG performed at study inclusion. Data will be required on renal function (creatinine and glomerular filtration rate and microalbuminuria), lipid parameters (cholesterol: total, HDLc, LDLc,), baseline glucose, glycated hemoglobin (HbA1c), liver biology (GOT, GPT, GGT), albumin and prealbumin, blood cell count, Ferritin and Transferrin saturation rate, natriuretic peptides.

In some centres blood sample will be collected to a further evaluation of biomarkers.

24-hour ABPM will be made using validated devices, ABPM device should be programmed to take measurements every 30 minutes . Patients will be instructed in their use. Periods of activity and rest will be pre-determined in short windows: In addition, the duration of ABPM (hours), the percentage of valid readings, and the mean SBP/DBP values during periods of activity, rest and in 24 hours will be recorded. Records with a duration \<24 hours, those without one good reading per hour and those with \<70% of satisfactory readings will be excluded. ABPM will be performed at baseline and at the final visit HBPM should be done by a trained individual (the patient or anyone else), with equipment validated, calibrated and provided with memory.

Only validated semiautomatic oscillometric arm cuff devices are recommended for these measurements. The functional status will be determined using the Barthel index, Cognitive impairment will be tested following the Montreal Cognitive Assessment with local adaptations.

The diagnosis of frailty will be made using the Short Physical Performance Battery In a subset of centres a 24H ambulatory ECG recording will be performed using a standard recording unit and automatically analyzed by a PC-based Holter system.

Eligibility Criteria:
Inclusion Criteria:

* Patients with a previous diagnosis of HF-PEF, defined by:
* At least a previous hospitalization due to heart failure
* Left ventricular ejection fraction (LVEF) ≥45% by echo during screening epoch, or within 6 months prior to study entry.
* Symptom(s) of heart failure (HF) and requiring, at least 30 days prior to study entry, hospitalization, or consultation to emergency room .
* Current symptom(s) of HF
* Structural heart disease documented by echocardiogram, namely septal or posterior wall thickness \>=1.1 cm) or LA enlargement (i.e., width \>=3.8 cm, length \>=5.0 cm, area \>=20 cm2, volume \>=55 ml, or volume index \>=29 ml/m
* Elevated NT-proBNP defined as NT-proBNP \>200 pg/ml if the patient had been hospitalized for HF within the past 9 months or \>300 pg/ml if not so.

Clinical and hemodynamic stability for at least 4 weeks before study inclusion, defined as stable treatment or functional class for at least 4 weeks before study inclusion, (changes in diuretic dosification are not considered as unstable treatment).

Exclusion Criteria:

* Any prior measurement of LVEF ≤ 40%.
* Acute coronary syndrome (including MI), cardiac surgery, other major CV surgery within 3 months , urgent percutaneous coronary intervention or limb amputation due to peripheral arterial disease or Stroke within 3 months or and elective PCI within 30 days prior to entry.
* Current acute decompensated HF requiring therapy.
* Changes in antihypertensive treatment (class type or dose) 4 weeks before inclusion, excluding changes in diuretics due to congestion.
* Alternative reason for shortness of breath such as: significant pulmonary disease or severe COPD, haemoglobin (Hgb) \<10 g/dl, or body mass index (BMI) \> 40 kg/m2.
* Systolic blood pressure (SBP) ≥ 180 mmHg or DBP ≥ 110 mmHg at entry.
* Patients with severe chronic renal disease, defined as GFR \<15 ml/min or haemodialysis.
* Inability to understand the study and participate voluntarily
* Patients diagnosed with cancer in the previous 12 months, and requiring treatment, at the time of study inclusion.
* Patients diagnosed with systemic autoimmune disease (lupus, vasculitis . . .)
* Patients not able to perform an ambulatory blood pressure measurement namely working at night, or patients with tachyarrhythmia.