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Circadian blood pressure changes and cardiovascular risk in elderly-treated hypertensive patients
Sante D Pierdomenico1,2, Anna M Pierdomenico2,3, Francesca Coccina3
1Dipartimento di Scienze Mediche, Orali e Biotecnologiche, Università "Gabriele d'Annunzio", Chieti-Pescara, Italy.
Insights
Circadian blood pressure (BP) changes significantly impact cardiovascular risk in elderly hypertensive patients. Specific patterns like reverse dipping and extreme dipping indicate higher risks, informing personalized treatment strategies.
Area of Science:
- Cardiology
- Hypertension Research
- Geriatric Medicine
Background:
- The prognostic significance of circadian blood pressure (BP) variations in treated hypertensive elderly patients remains incompletely understood.
- Understanding these patterns is crucial for refining cardiovascular risk assessment in this demographic.
Purpose of the Study:
- To investigate the association between different patterns of circadian BP changes and cardiovascular risk.
- To evaluate the prognostic value of nighttime BP dipping and morning surge in elderly hypertensive individuals.
Main Methods:
- A cohort of 1191 elderly-treated hypertensive patients (60-90 years) was followed for a mean of 9.1 years.
- Patients were categorized based on systolic BP nighttime dipping and morning surge (MS) into dippers (normal/high MS), non-dippers (ND), reverse dippers (RD), and extreme dippers (normal/high MS).
- Composite cardiovascular events (stroke, coronary events, heart failure, peripheral revascularization) were recorded and analyzed using adjusted hazard ratios (HR) and population attributable risk.
Main Results:
- A composite end point occurred in 392 patients (3.63 per 100 patient-years).
- After adjusting for covariates, high MS dippers (HR 1.49), ND (HR 1.71), RD (HR 2.05), and extreme high MS dippers (HR 3.40) showed significantly higher cardiovascular risk compared to normal MS dippers.
- The highest individual risk was observed in extreme high MS dippers, while reverse dippers posed the greatest population-level risk.
Conclusions:
- Circadian BP patterns, including nighttime dipping and morning surge, are independently associated with cardiovascular risk in elderly treated hypertensive patients.
- Identifying specific patterns like reverse dipping and extreme high MS dipping can help stratify risk and guide preventative strategies.
- These findings underscore the importance of monitoring circadian BP variations for improved cardiovascular outcomes in the elderly hypertensive population.
Abstract:
The independent prognostic significance of circadian blood pressure (BP) changes is unclear. We investigated the association between circadian BP changes and cardiovascular risk among elderly-treated hypertensive patients. The occurrence of a composite end point (that is, stroke, coronary events, heart failure and peripheral revascularization) was evaluated among 1191 elderly-treated hypertensive patients (age range 60-90 years). According to the nighttime change and the morning surge (MS) of systolic BP, subjects were divided into groups of dippers with a normal or high MS (DNMS and DHMS, respectively), non-dippers (ND), reverse dippers (RD) and extreme dippers with a normal or high MS (EDNMS and EDHMS, respectively). During the follow-up (9.1±4.9 years, range 0.4-20 years), 392 events occurred. The event rate was 3.63 per 100 patient-years. After adjustment for various covariates, including 24-h BP, the DHMS (hazard ratio (HR) 1.49, 95% confidence interval (CI) 1.02-2.16, P=0.04), ND (HR 1.71, 95% CI 1.28-2.27, P=0.0001), RD (HR 2.05, 95% CI 1.44-2.93, P=0.0001) and EDHMS (HR 3.40, 95% CI 1.96-5.90, P=0.001) were at higher cardiovascular risk than the DNMS. The population attributable risk was 0.6, 7.1, 7.3 and 1.4% for the DHMS, ND, RD and EDHMS, respectively. In elderly-treated hypertensive patients, circadian BP changes were independently associated with increased cardiovascular risk. At the patient level, the highest risk was observed among the EDHMS, followed by the RD, ND and DHMS. At the population level, the highest risk was observed among the RD, followed by the ND, EDHMS and DHMS.
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