Short-term blood pressure variability as an indicator of the adaptive capacity of patients with chronic heart failure

doi:10.5493/wjem.v15.i4.110904

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World Journal of Experimental Medicine

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2220-315x

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Exp Med. Dec 20, 2025; 15(4): 110904
Published online Dec 20, 2025. doi: 10.5493/wjem.v15.i4.110904

Short-term blood pressure variability as an indicator of the adaptive capacity of patients with chronic heart failure

Natalia S Akimova, Larisa E Konshina, Anastasiya E Runnova, Maksim O Zhuravlev, Tatyana M Bogdanova, Anton R Kiselev, Yury G Shvarts

Natalia S Akimova, Larisa E Konshina, Yury G Shvarts, Department of Faculty Therapy, V.I. Razumovsky Saratov State Medical University, Saratov 410012, Saratovskaya Oblast’, Russia

Anastasiya E Runnova, Maksim O Zhuravlev, Laboratory of Open Biosystems and Artificial Intelligence, V.I. Razumovsky Saratov State Medical University, Saratov 410012, Saratovskaya Oblast’, Russia

Anastasiya E Runnova, Maksim O Zhuravlev, Anton R Kiselev, Coordinating Center for Fundamental Research, National Medical Research Center for Therapy and Preventive Medicine, Moscow 101990, Moskva, Russia

Tatyana M Bogdanova, Department of Propaedeutics of Internal Medicine, V.I. Razumovsky Saratov State Medical University, Saratov 410012, Saratovskaya Oblast’, Russia

Co-corresponding authors: Larisa E Konshina and Anton R Kiselev.

Author contributions: Akimova NS, Konshina LE, Runnova AE contributed to concept and design of research, collection and processing of material, text writing; Akimova NS, Konshina LE, Zhuravlev MO, Bogdanova TM contributed to collection and processing of material; Akimova NS, Konshina LE contributed to text writing; Shvarts YG, Kiselev AR contributed to statistical processing of the material; Akimova NS, Shvarts YG, Kiselev AR contributed to scientific editing; all authors have read and approve the final manuscript.

Supported by Ministry of Health of the Russian Federation titled Development of a Hardware-Software Complex for the Non-Invasive Monitoring and Prediction of Circulatory Decompensation in Patients with Chronic Heart Failure, No. 125030703255-7.

Institutional review board statement: The study was reviewed and approved by the local Ethics Committee at the Federal State Budgetary Educational Institution of Higher Education "Saratov State Medical University named after V. I. Razumovsky" of the Ministry of Health of the Russian Federation, Protocol No. 12 dated April 01, 2025, and complied with the requirements of the Helsinki Declaration of 1964 and its revised version of 2024.

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: The authors declare no conflict of interest.

STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Data sharing statement: No additional data are available.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Anton R Kiselev, Head, Professor, Coordinating Center for Fundamental Research, National Medical Research Center for Therapy and Preventive Medicine, Petroverigsky per., 10, str. 3, Moscow 101990, Moskva, Russia. antonkis@list.ru

Received: June 18, 2025
Revised: July 15, 2025
Accepted: October 22, 2025
Published online: December 20, 2025
Processing time: 184 Days and 15 Hours

Abstract

BACKGROUND

The six-minute walk test (6MWT) allows to determine, in addition to the main parameters, the time of heart rate recovery (THRR), cardiac function, adaptation index (AI), which characterize the compensatory reserve of patients with chronic heart failure (CHF). At the same time, the significance of these parameters in patients taking beta-blockers for CHF is insufficiently studied, taking into account the negative chronotropic effect of drugs. In this regard, it is relevant to identify factors that can characterize the compensatory capabilities of a patient with CHF during 6MWT, not related to the calculation of heart rate.

AIM

To identify hemodynamic indicators of the adaptive capabilities of patients with CHF during paired 6MWT depending on their intake of beta-blockers.

METHODS

Seventy-four patients with compensated CHF due to coronary heart disease and/or hypertension formed the main group, comprising 46 individuals who were taking beta-blockers, and a comparison group comprising 28 individuals who had not been taking beta-blockers for at least one month before 6MWT. All participants underwent Doppler echocardiography (DECG), paired 6MWT, with assessment of hemodynamic parameters before and after both the first and second test. AI, THRR, blood pressure variability (BPV) were calculated. Multivariate, correlation analyses, univariate analysis of variance were used.

RESULTS

There were no significant associations between adaptation characteristics and DECG parameters or functional class (FC) of CHF in patients of the main group. In the comparison group, the indicators of compensatory reserve were significantly and directly associated with left ventricular ejection fraction (LVEF), and inversely with FC CHF and cardiac cavity size. In both groups, a greater difference in systolic blood pressure between the end of the first and the beginning of the second 6MWT was significantly associated with a higher index of right ventricular systolic dysfunction (Tricuspid annular plane systolic excursion) and LVEF, as well as a smaller left ventricular size and mass, and a lower pulmonary artery systolic pressure in patients in the main group.

CONCLUSION

Systolic BPV, measured immediately after 6MWT and 20 minutes after its completion, can indirectly characterize the compensatory reserve in patients with CHF, regardless of their beta-blocker intake.

Keywords: Six-minute walk test; Chronic heart failure; Blood pressure variability; Adaptive capacity; Beta-blockers

Core Tip: Analysis of hemodynamics was conducted during six-minute walk test (6MWT) of patients with chronic heart failure (CHF). In patients who were taking beta-blockers, assessment of the compensatory reserve using routine methods was not significantly correlated with the severity of CHF. It was found that the assessment of short-term systolic blood pressure variability (BPV), measured immediately after 6MWT and 20 minutes after its completion, can characterize the compensatory reserve in CHF, regardless of whether they are taking beta blockers. Monitoring BPV during routine 6MWT might help doctors personalize recommendations for patients with CHF who are taking beta blockers.