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[Prognostic value of the degree of night decrease of systolic pressure in patients with mild and moderate forms of
Insights
Insufficient nocturnal fall of systolic blood pressure (SBP) is linked to increased cardiovascular events in men with essential hypertension. This finding highlights the importance of monitoring BP rhythm for predicting cardiac risks.
Area of Science:
- Cardiology
- Hypertension Research
- Chronobiology
Context:
- Essential hypertension (EH) affects a significant portion of the adult population.
- Cardiovascular events (CE) remain a leading cause of morbidity and mortality worldwide.
- Circadian blood pressure (BP) rhythm, specifically the nocturnal fall of SBP, is increasingly recognized as a crucial factor in cardiovascular health.
Purpose:
- To investigate the relationship between the circadian BP rhythm and the incidence of cardiovascular events (CE) over a 7-9 year follow-up period.
- To analyze the prognostic value of insufficient nocturnal fall of systolic blood pressure (NF SBP) in males with mild to moderate EH.
- To assess the impact of left ventricular mass index (LVMI) in conjunction with BP rhythm on cardiovascular outcomes.
Summary:
- This prospective study followed 50 males with mild to moderate EH for approximately 8.4 years.
- Patients were categorized based on their nocturnal SBP fall (normal vs. insufficient) and LVMI (normal vs. increased).
- A significantly higher incidence of cardiovascular events, including myocardial infarction, stroke, and sudden death, was observed in patients with an insufficient nocturnal SBP fall and/or increased LVMI.
Impact:
- Identifies insufficient nocturnal SBP fall as a significant adverse prognostic factor for cardiovascular morbidity in hypertensive males.
- Underscores the clinical relevance of assessing circadian BP patterns for risk stratification in essential hypertension.
- Provides evidence supporting closer monitoring and potentially tailored therapeutic strategies for hypertensive individuals with blunted nocturnal BP dipping.
Aim:
To study a relationship between a carcadian blood pressure (BP) rhythm and cardiovascular events (CE) during 7-9 year follow-up in males with mild to moderate essential hypertension (EH).
Material And Methods:
50 males (mean age 48.6 +/- 0.7 years) with mild to moderate EH were prospectively followed up for 7-9 years (8.4 +/- 0.1 years). We analysed 24-h BP recordings and protocol of echocardiography performed during the first hospitalization. The patients were divided into three groups: group 1 (n = 18) with normal (10-20%) nocturnal fall of systolic BP (NF SBP) and normal left ventricular mass index (LVMI < 125 g/m2); group 2 (n = 16) with insufficient (< 10%) NF SBP and normal LVMI; group 3 (n = 16) with LVMI > 125 g/m2. In these groups we assessed the prevalence of CE: myocardial infarction (MI), stroke (S), sudden death (SD), new cases of angina pectoris (AP), transient cerebral ischemic attack (TIA).
Results:
No significant differences were found between the groups by mean age, body mass index, duration of arterial hypertension, mean 24-h and awake systolic and diastolic BP while significant differences were by nighttime BP profile parameters. During the follow-up 16 CE in 12 patients were documented (3 fatal and 13 nonfatal). In group 1 CE were observed in 1 patient (twice MI), in group 2-7 cases of CE (1 S, 1 TCIA, 2 MI, 2 AP) in 6 patients, in group 3-7 cases (2 MI, 3 TIA, 2 AP) in 5 patients, 3 of them were fatal.
Conclusion:
Insufficient nocturnal fall of SBP (< 10%) is an adverse prognostic factor for cardiovascular morbidity in mild to moderate essential male hypertensives.