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Published on: June 10, 2025

Association Between Disruption of Blood Pressure Circadian Rhythm and Prognosis After Acute Anterior Myocardial

Yangge Shao1, Yajuan Yang1, Chao Wang1

  • 1Department of Cardiology, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, China.

Clinical Cardiology
|August 3, 2026
PubMed

Insights

Patients with ST-elevation myocardial infarction (STEMI) exhibit disrupted blood pressure (BP) circadian rhythms, with reverse dipper BP independently linked to major adverse cardiovascular events (MACE). This highlights the prognostic significance of BP patterns post-myocardial infarction.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Circadian Biology

Background:

  • Circadian rhythm disruption is increasingly recognized in cardiovascular diseases.
  • Blood pressure (BP) circadian patterns, such as 'dipping,' are crucial indicators of cardiovascular health.
  • Anterior ST-elevation myocardial infarction (STEMI) is a critical condition often associated with complex physiological changes.

Purpose of the Study:

  • To characterize blood pressure (BP) circadian rhythm disruption in patients with acute anterior ST-elevation myocardial infarction (STEMI).
  • To evaluate the relationship between different BP circadian rhythms and prognosis, specifically major adverse cardiovascular events (MACE), after emergency percutaneous coronary intervention (PCI).

Main Methods:

  • 330 anterior STEMI patients undergoing emergency PCI (MI group) and 131 controls were assessed using 24-hour ambulatory blood pressure monitoring (ABPM).
  • BP rhythms were classified into Extreme dipper, Dipper, Non-dipper, and Reverse dipper categories.
  • Patients were followed for 1 year post-PCI to compare MACE occurrence among BP rhythm subgroups.

Main Results:

  • The MI group showed significantly lower proportions of dipper BP (11.21%) and higher proportions of non-dipper (43.03%) and reverse dipper (40%) BP compared to controls.
  • Reverse dipper BP was independently associated with increased MACE risk (Hazard Ratio = 6.417, p=0.002) in multivariate Cox regression analysis.
  • The cumulative risk of primary endpoint events was significantly higher in the reverse dipper group than the dipper group (Log Rank p=0.021).

Conclusions:

  • Patients with anterior STEMI frequently exhibit disrupted BP circadian rhythms, characterized by a reduced prevalence of the dipper pattern.
  • The reverse dipper BP rhythm emerges as a significant independent predictor of MACE in this patient population.
  • Monitoring and addressing BP circadian rhythm abnormalities, particularly the reverse dipper pattern, may be crucial for improving outcomes after anterior STEMI.
Abstract

Keywords:
MACEPCIanterior STEMIblood pressurecircadian rhythm

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