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Diurnal blood pressure pattern and risk of congestive heart failure
Erik Ingelsson1, Kristina Björklund-Bodegård, Lars Lind
1Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. erik.ingelsson@pubcare.uu.se
Insights
Nighttime blood pressure patterns, specifically "nondipping," significantly predict congestive heart failure (CHF) risk in elderly men. This finding offers new insights beyond traditional blood pressure measurements for CHF prevention.
Area of Science:
- Cardiology
- Hypertension Research
- Preventive Medicine
Background:
- High blood pressure is a primary risk factor for congestive heart failure (CHF).
- The impact of altered diurnal blood pressure patterns on subsequent CHF risk is not well understood.
Purpose of the Study:
- To evaluate 24-hour ambulatory blood pressure characteristics as predictors of CHF incidence.
- To determine if altered diurnal blood pressure patterns provide additional risk information beyond conventional office measurements.
Main Methods:
- Prospective, community-based observational cohort study of 951 elderly men without CHF at baseline.
- 24-hour ambulatory blood pressure monitoring performed at baseline.
- Analysis of blood pressure variables as predictors of subsequent CHF hospitalization.
Main Results:
- A 1-SD increase in nighttime diastolic blood pressure (HR, 1.26) and "nondipping" blood pressure (HR, 2.29) were associated with increased CHF risk.
- "Nondipping" remained a significant predictor even after adjusting for office blood pressure measurements (HR, 2.21).
- These associations persisted after excluding participants with myocardial infarction.
Conclusions:
- Nighttime blood pressure patterns, particularly "nondipping," provide significant risk information for CHF.
- This information is incremental to conventional office blood pressure readings and established risk factors.
- Further research is needed to establish the clinical utility of these findings.
Context:
High blood pressure is the most important risk factor for congestive heart failure (CHF) at a population level, but the relationship of an altered diurnal blood pressure pattern to risk of subsequent CHF is unknown.
Objectives:
To explore 24-hour ambulatory blood pressure characteristics as predictors of CHF incidence and to investigate whether altered diurnal blood pressure patterns confer any additional risk information beyond that provided by conventional office blood pressure measurements.
Design, Setting, And Participants:
Prospective, community-based, observational cohort in Uppsala, Sweden, including 951 elderly men free of CHF, valvular disease, and left ventricular hypertrophy at baseline between 1990 and 1995, followed up until the end of 2002. Twenty-four-hour ambulatory blood pressure monitoring was performed at baseline, and the blood pressure variables were analyzed as predictors of subsequent CHF.
Main Outcome Measure:
First hospitalization for CHF.
Results:
Seventy men developed heart failure during follow-up, with an incidence rate of 8.6 per 1000 person-years at risk. In multivariable Cox proportional hazards models adjusted for antihypertensive treatment and established risk factors for CHF (myocardial infarction, diabetes, smoking, body mass index, and serum cholesterol level), a 1-SD (9-mm Hg) increase in nighttime ambulatory diastolic blood pressure (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.02-1.55) and the presence of "nondipping" blood pressure (night-day ambulatory blood pressure ratio > or =1; HR, 2.29; 95% CI, 1.16-4.52) were associated with an increased risk of CHF. After adjusting for office-measured systolic and diastolic blood pressures, nondipping blood pressure remained a significant predictor of CHF (HR, 2.21; 95% CI, 1.12-4.36 vs normal night-day pattern). Nighttime ambulatory diastolic blood pressure and nondipping blood pressure were also significant predictors of CHF after exclusion of all participants who had an acute myocardial infarction before baseline or during follow-up.
Conclusions:
Nighttime blood pressure appears to convey additional risk information about CHF beyond office-measured blood pressure and other established risk factors for CHF. The clinical value of this association remains to be established in future studies.
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