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The Prognostic Effect of Circadian Blood Pressure Pattern on Long-Term Cardiovascular Outcome is Independent of Left
Marijana Tadic1, Cesare Cuspidi2, Vera Celic3
1Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353 Berlin, Germany.
Insights
The reverse-dipping blood pressure (BP) pattern predicts adverse cardiovascular events in hypertensive patients, independent of nighttime BP and heart remodeling. This highlights the importance of BP pattern assessment for long-term cardiovascular risk prediction.
Area of Science:
- Cardiology
- Hypertension Research
- Predictive Medicine
Background:
- Hypertension is a major risk factor for cardiovascular disease.
- Predicting adverse cardiovascular (CV) outcomes in hypertensive patients is crucial for effective management.
- 24-hour blood pressure (BP) monitoring offers insights beyond routine measurements.
Purpose of the Study:
- To evaluate the predictive value of 24-hour BP patterns for adverse CV outcomes in untreated hypertensive patients.
- To identify independent predictors of CV events among various BP patterns and cardiac structural/functional parameters.
- To assess the role of BP patterns in long-term CV risk stratification.
Main Methods:
- Inclusion of 533 initially untreated hypertensive patients (2007-2012).
- Baseline assessments included laboratory analysis, 24-hour BP monitoring, and echocardiography.
- Median follow-up of nine years for adverse CV events (hospitalization for AF, MI, revascularization, HF, stroke, or CV death).
Main Results:
- 85 patients experienced adverse CV events during follow-up.
- Nighttime systolic BP (SBP), non-dipping BP pattern, left ventricular hypertrophy (LVH), left atrial enlargement (LAE), and LV diastolic dysfunction (LV DD) were identified as risk factors.
- Nighttime SBP, non-dipping BP pattern, LVH, and LV DD emerged as independent predictors.
- The reverse-dipping BP pattern was identified as an independent predictor of CV events, irrespective of nighttime SBP and LV remodeling.
Conclusions:
- The reverse-dipping BP pattern is a significant independent predictor of adverse cardiovascular events in hypertensive individuals.
- Assessment of 24-hour BP patterns, particularly the reverse-dipping phenomenon, is vital for long-term CV risk prediction in the hypertensive population.
- BP pattern analysis complements traditional risk factors and cardiac remodeling assessments for improved cardiovascular risk stratification.
Abstract:
We aimed to investigate the predictive value of 24 h blood pressure (BP) patterns on adverse cardiovascular (CV) outcome in the initially untreated hypertensive patients during long-term follow-up. This study included 533 initially untreated hypertensive patients who were involved in this study in the period between 2007 and 2012. All participants underwent laboratory analysis, 24 h BP monitoring, and echocardiographic examination at baseline. The patients were followed for a median period of nine years. The adverse outcome was defined as the hospitalization due to CV events (atrial fibrillation, myocardial infarction, myocardial revascularization, heart failure, stroke, or CV death). During the nine-year follow-up period, adverse CV events occurred in 85 hypertensive patients. Nighttime SBP, non-dipping BP pattern, LV hypertrophy (LVH), left atrial enlargement (LAE), and LV diastolic dysfunction (LV DD) were risk factors for occurrence of CV events. However, nighttime SBP, non-dipping BP pattern, LVH, and LV DD were the only independent predictors of CV events. When all four BP pattern were included in the model, non-dipping and reverse dipping BP patterns were associated with CV events, but only reverse-dipping BP pattern was independent predictor of CV events. The current study showed that reverse-dipping BP pattern was predictor of adverse CV events independently of nighttime SBP and LV remodeling during long-term follow-up. The assessment of BP patterns has very important role in the long-time prediction in hypertensive population.
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