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Morning Blood Pressure Surge, Dipping, and Risk of Coronary Events in Elderly Treated Hypertensive Patients
Sante D Pierdomenico1, Anna M Pierdomenico2, Roberta Di Tommaso3
1Dipartimento di Medicina e Scienze dell'Invecchiamento, Università "Gabriele d'Annunzio", Chieti, Italy; Centro di Ricerca Clinica, Fondazione Università "Gabriele d'Annunzio", Chieti, Italy. pierdomenico@unich.it.
Insights
High morning surge in systolic blood pressure predicts coronary events in elderly treated hypertensive patients who are dippers. Nondippers face higher coronary event risk regardless of blood pressure surge.
Area of Science:
- Cardiology
- Hypertension Research
- Geriatric Medicine
Background:
- The prognostic value of morning blood pressure surge (MS) in elderly treated hypertensive patients remains unclear.
- Investigating the association between systolic blood pressure MS and coronary events is crucial for risk stratification.
Purpose of the Study:
- To determine the independent prognostic significance of systolic blood pressure morning surge (MS) on coronary events in elderly treated hypertensive individuals.
- To explore whether dipping status modifies the association between MS and coronary event risk.
Main Methods:
- A cohort of 1,191 elderly treated hypertensive patients (60-90 years) was followed for coronary events.
- Patients were stratified by tertiles of systolic BP MS, dipping status (dippers vs. nondippers), and group-specific tertiles for dippers and nondippers.
Main Results:
- Over 9.1 years, 120 coronary events occurred. Overall, systolic BP MS was not significantly associated with coronary risk.
- Nondippers exhibited a higher risk of coronary events compared to dippers.
- In dippers, high MS (>23 mm Hg) was associated with increased coronary event risk (HR 1.912), while in nondippers, the risk was elevated independently of MS (HR 1.739).
Conclusions:
- High morning surge of systolic blood pressure is a significant predictor of coronary events specifically in elderly treated hypertensive dippers.
- Nondippers, irrespective of their morning blood pressure surge, present an elevated risk for coronary events.
- These findings highlight the importance of considering both dipping status and blood pressure surge patterns for comprehensive cardiovascular risk assessment in hypertensive elderly patients.
Background:
The independent prognostic significance of morning surge (MS) of blood pressure (BP) is not yet clear. We investigated the association between MS of systolic BP and risk of coronary events in elderly treated hypertensive patients.
Methods:
The occurrence of coronary events was evaluated in 1,191 elderly treated hypertensive patients (age range 60-90 years). Subjects were divided according to tertiles of MS of systolic BP of the population as a whole, by dipping status and by group-specific tertiles of MS of systolic BP in dippers and nondippers.
Results:
During the follow-up (9.1 ± 4.9 years, range 0.4-20 years), 120 coronary events occurred. In the population as a whole, coronary event risk was not significantly associated with tertiles of MS of systolic BP, whereas nondippers were at higher risk than dippers. When nondippers and dippers were analyzed separately, by group-specific tertiles of MS of systolic BP, coronary event risk was associated with MS of systolic BP in dippers but not in nondippers. After adjustment for various covariates, Cox regression analysis showed that dippers in the third tertile (>23 mm Hg) of MS of systolic BP (hazard ratio 1.912, 95% confidence interval 1.048-3.488, P = 0.03) and nondippers (hazard ratio 1.739, 95% confidence interval 1.074-2.815, P = 0.02) were at higher coronary event risk than dippers with MS of systolic BP <23 mm Hg .
Conclusions:
In elderly treated hypertensive patients, high MS of systolic BP predicts coronary events in dippers but not in nondippers. Nondippers, however, show higher risk of coronary events independently of MS in systolic BP.
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