Related Experiment Video
Updated: May 6, 2026
Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
Published on: June 10, 2025
A reverse dipping pattern predicts cardiovascular mortality in a clinical cohort
Bae Keun Kim1, Yu-Mi Kim, Youngu Lee
1Division of Cardiology, Department of Internal Medicine, Sung Ae Hospital, Seoul, Korea.
Insights
An abnormal dipping pattern in blood pressure monitoring is a significant cardiovascular risk. Patients classified as "risers" face a threefold greater risk of cardiovascular death compared to others.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Epidemiology
Background:
- Abnormal dipping patterns in ambulatory blood pressure monitoring (ABPM) are recognized cardiovascular risk factors.
- The clinical impact of these patterns on cardiovascular (CV) mortality requires further investigation for standard parameter consideration.
Purpose of the Study:
- To assess the association between abnormal dipping patterns and increased CV mortality.
- To investigate the clinical significance of blood pressure dipping in a Korean tertiary hospital cohort.
Main Methods:
- Retrospective cohort study of 401 patients undergoing ABPM (1994-1996).
- Patients categorized into 'risers' (<0% systolic BP drop) and 'others' (dippers and non-dippers).
- 120-month follow-up for CV mortality using Cox regression analysis, adjusting for covariates.
Main Results:
- CV mortality was 14.0% in risers versus 5.8% in others.
- Risers showed a significantly greater risk of CV death (RR, 3.02; P=0.022) after adjustment.
- No significant difference in event rates was observed between dippers and non-dippers.
Conclusions:
- The 'riser' blood pressure dipping pattern is strongly associated with increased CV mortality.
- Abnormal dipping patterns, particularly reverse dipping, may be more prevalent in clinical practice.
- These findings highlight the prognostic value of ABPM dipping patterns in cardiovascular risk assessment.
Abstract:
An abnormal dipping pattern in ambulatory blood pressure monitoring (ABPM) is a cardiovascular (CV) risk factor. However, its impact on CV mortality has not been investigated sufficiently in clinical practice to be considered a standard parameter. We assessed the association between abnormal dipping patterns and increased CV mortality in a tertiary hospital in Korea. Our retrospective cohort study included 401 patients who underwent ABPM between 1994 and 1996 in Hanyang University Hospital, Seoul, Korea. The patients were classified as risers (<0% drop in systolic BP; n=107), and others included dippers and non-dippers (≥0% drop, n=294). The follow-up period was 120 months. The frequency of CV mortality was 14.0% in risers and 5.8% in others. A Cox regression analysis found a significant association between dipping pattern and CV mortality, after adjusting for age, gender, body mass index, hypertension, diabetes mellitus, smoking and hypercholesterolemia. Risers were at greater risk of CV death than others (RR, 3.02, P=0.022), but there was no difference in event rates between dippers and non-dippers. The reverse dipping pattern may be more frequent in clinical settings than in the population at large, and it is strongly associated with increased risk of CV mortality in Korea.
