Prognostic significance of 24-h ambulatory blood pressure characteristics for cardiovascular morbidity in a population of elderly men

Björklund, Kristina; Lind, Lars; Zethelius, Björn; Berglund, Lars; Lithell, Hans

doi:10.1097/00004872-200409000-00012

Cited by 145 publications

(116 citation statements)

References 29 publications

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“…By contrast, Hansen et al 17 observed that the night-day BP ratio was significant for CVD events in subjects with elevated daytime ABP, but not in subjects with normal daytime ABP, and these results persisted after adjustment for 24-h ABP. Finally, the night-day BP ratio did not carry any prognostic information in the study by Bjö rklund et al 20 in a population of elderly men.…”

Section: Discussionmentioning

confidence: 66%

Night–day blood pressure ratio and dipping pattern as predictors of death and cardiovascular events in hypertension

et al. 2009

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Our objective was to assess the prognostic significance of the night-time dipping pattern and the night-day blood pressure (BP) ratio for mortality and cardiovascular events in hypertensive patients without major cardiovascular disease at baseline. We performed a meta-analysis on individual data of 3468 patients from four prospective studies performed in Europe. Age of the subjects averaged 61±13 years; 45% were men and 61% were under antihypertensive treatment at the time of ambulatory BP monitoring. The night-day BP ratio and 24-h BP averaged, respectively, 0.907±0.085/ 0.866±0.095 and 138.1±16.4/82.3±11.0 mm Hg. Total follow-up time amounted to 23 164 patient-years. We used multivariable Cox regression analysis to assess the outcome of reverse dippers, non-dippers and extreme dippers vs dippers, and to assess the hazard ratios associated with 1 standard deviation higher night-day BP ratio. In comparison with dippers, and with adjustment for confounders and 24-h BP, the incidence of cardiovascular events was worse in reverse dippers (Pp0.05), whereas mortality was lower in extreme dippers (Pp0.01); outcome was similar in non-dippers and dippers. The systolic night-day BP ratio independently predicted all-cause mortality and cardiovascular events (Pp0.001), which persisted after additional adjustment for 24-h BP (Pp0.05); appropriate interaction terms indicated that the results were similar in men and women, in younger and older patients and in treated and untreated patients. In conclusion, the dipping pattern and the night-day BP ratio significantly and independently predict mortality and cardiovascular events in hypertensive patients without history of major cardiovascular disease, even after adjustment for 24-h BP.

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Section: Discussionmentioning

confidence: 66%

Night–day blood pressure ratio and dipping pattern as predictors of death and cardiovascular events in hypertension

et al. 2009

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“…Possible limitations of previous studies were a lack of statistical power, 2-5 selection of specific groups of patients, [5][6][7] categorization of variability by arbitrary cutoff points, 2,4,[7][8][9] and sole reliance on fatal end points. 10,11 Moreover, various parameters can capture short-term blood pressure variability over 24 hours, but most studies only considered the SD of systolic 4,6,12 or diastolic blood pressure or both. 8 -10 To address the prognostic value of short-term blood pressure variability, we expanded, updated, and analyzed the International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcome.…”

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confidence: 99%

Prognostic Value of Reading-to-Reading Blood Pressure Variability Over 24 Hours in 8938 Subjects From 11 Populations

et al. 2010

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Abstract-In previous studies, of which several were underpowered, the relation between cardiovascular outcome and blood pressure (BP) variability was inconsistent. We followed health outcomes in 8938 subjects (mean age: 53.0 years; 46.8% women) randomly recruited from 11 populations. At baseline, we assessed BP variability from the SD and average real variability in 24-hour ambulatory BP recordings. We computed standardized hazard ratios (HRs) while stratifying by cohort and adjusting for 24-hour BP and other risk factors. Over 11.3 years (median), 1242 deaths (487 cardiovascular) occurred, and 1049, 577, 421, and 457 participants experienced a fatal or nonfatal cardiovascular, cardiac, or coronary event or a stroke.Higher diastolic average real variability in 24-hour ambulatory BP recordings predicted (PՅ0.03) total (HR: 1.14) and cardiovascular (HR: 1.21) mortality and all types of fatal combined with nonfatal end points (HR: Ն1.07) with the exception of cardiac and coronary events (HR: Յ1.02; PՆ0.58). Higher systolic average real variability in 24-hour ambulatory BP recordings predicted (PϽ0.05) total (HR: 1.11) and cardiovascular (HR: 1.16) mortality and all fatal combined with nonfatal end points (HR: Ն1.07), with the exception of cardiac and coronary events (HR: Յ1.03; PՆ0.54). SD predicted only total and cardiovascular mortality. While accounting for the 24-hour BP level, average real variability in 24-hour ambulatory BP recordings added Ͻ1% to the prediction of a cardiovascular event. Sensitivity analyses considering ethnicity, sex, age, previous cardiovascular disease, antihypertensive treatment, number of BP readings per recording, or the night:day BP ratio were confirmatory. In conclusion, in a large population cohort, which provided sufficient statistical power, BP variability assessed from 24-hour ambulatory recordings did not contribute much to risk stratification over and beyond 24-hour BP. (Hypertension. 2010;55:1049-1057.)Key Words: blood pressure variability Ⅲ ambulatory blood pressure Ⅲ population science Ⅲ risk factors Ⅲ epidemiology A mbulatory blood pressure monitoring not only provides information on the blood pressure level but on the diurnal changes in blood pressure as well. Blood pressure variability includes both short-term and circadian components, which can be estimated by the SD of the blood pressure values over a defined period of the day or by the night:day blood pressure ratio, respectively. We recently reported in Ͼ7000 subjects recruited from 6 populations on the prognos- Although the aforementioned analyses shed light on the association between outcome and long-term blood pressure variability, the predictive value of short-term reading-toreading blood pressure variability remains uncertain. Possible limitations of previous studies were a lack of statistical power, 2-5 selection of specific groups of patients, 5-7 categorization of variability by arbitrary cutoff points, 2,4,7-9 and sole reliance on fatal end points. 10,11 Moreover, various parameters can capture short-term b...

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“…On the contrary, the night-to-day ratio of systolic and diastolic BP was not associated with CV morbidity in this cohort, irrespective of the cutoff value used for the definition of nondipping. 42 These results diverge greatly from the findings of the Systolic Hypertension in Europe (Syst-Eur) study 43 and the PIUMA (Progetto Ipertensione Umbria Monitoraggio Ambulatoriale) study, 44 in which the nondipping BP pattern was a predictor of CV morbidity.…”

Section: Elderlymentioning

confidence: 85%

Increased nighttime blood pressure or nondipping profile for prediction of cardiovascular outcomes

et al. 2010

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At present, clinic blood pressure (BP) evaluation is being increasingly complemented by ambulatory BP measurements for the evaluation of haemodynamic patterns during daily activities and sleep. Nondipping pattern, a measure of decreased attenuation of nighttime over daytime BP, has been correlated with enhanced target organ damage and adverse cardiovascular (CV) outcomes in different clinical settings beyond pure hypertensive cohorts. As the nondipping pattern is a derivative extract of both daytime and nighttime BP, it is yet questionable whether the crude estimate of nocturnal BP is superior to daytime BP and nondipping pattern in the prediction of subclinical damage and CV events. In this review, we aimed at comparing the CV predictive value of the nondipping pattern with that of nocturnal BP using cross-sectional and longitudinal data obtained from different cohort studies within the past 10 years. Our findings suggest that nocturnal BP including the phenotype of isolated nocturnal hypertension is better associated with CV target organ damage and 'hard end points' as compared with the nondipping pattern.

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Prognostic significance of 24-h ambulatory blood pressure characteristics for cardiovascular morbidity in a population of elderly men

Cited by 145 publications

References 29 publications

Night–day blood pressure ratio and dipping pattern as predictors of death and cardiovascular events in hypertension

Night–day blood pressure ratio and dipping pattern as predictors of death and cardiovascular events in hypertension

Prognostic Value of Reading-to-Reading Blood Pressure Variability Over 24 Hours in 8938 Subjects From 11 Populations

Increased nighttime blood pressure or nondipping profile for prediction of cardiovascular outcomes

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