Diurnal Blood Pressure Pattern and Risk of Congestive Heart Failure

Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Uppsala, Sweden
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 07/2006; 295(24):2859-66. DOI: 10.1001/jama.295.24.2859
Source: PubMed


High blood pressure is the most important risk factor for congestive heart failure (CHF) at a population level, but the relationship of an altered diurnal blood pressure pattern to risk of subsequent CHF is unknown.
To explore 24-hour ambulatory blood pressure characteristics as predictors of CHF incidence and to investigate whether altered diurnal blood pressure patterns confer any additional risk information beyond that provided by conventional office blood pressure measurements.
Prospective, community-based, observational cohort in Uppsala, Sweden, including 951 elderly men free of CHF, valvular disease, and left ventricular hypertrophy at baseline between 1990 and 1995, followed up until the end of 2002. Twenty-four-hour ambulatory blood pressure monitoring was performed at baseline, and the blood pressure variables were analyzed as predictors of subsequent CHF.
First hospitalization for CHF.
Seventy men developed heart failure during follow-up, with an incidence rate of 8.6 per 1000 person-years at risk. In multivariable Cox proportional hazards models adjusted for antihypertensive treatment and established risk factors for CHF (myocardial infarction, diabetes, smoking, body mass index, and serum cholesterol level), a 1-SD (9-mm Hg) increase in nighttime ambulatory diastolic blood pressure (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.02-1.55) and the presence of "nondipping" blood pressure (night-day ambulatory blood pressure ratio > or =1; HR, 2.29; 95% CI, 1.16-4.52) were associated with an increased risk of CHF. After adjusting for office-measured systolic and diastolic blood pressures, nondipping blood pressure remained a significant predictor of CHF (HR, 2.21; 95% CI, 1.12-4.36 vs normal night-day pattern). Nighttime ambulatory diastolic blood pressure and nondipping blood pressure were also significant predictors of CHF after exclusion of all participants who had an acute myocardial infarction before baseline or during follow-up.
Nighttime blood pressure appears to convey additional risk information about CHF beyond office-measured blood pressure and other established risk factors for CHF. The clinical value of this association remains to be established in future studies.

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    • "Other evidences indicate that an abnormal pattern of cyclic variation of BP (circadian or seasonal) is correlated well with an increased cardiovascular risk [29]. For example, excessive increase of BP just after rising in the morning, blunt, or nondipping of nocturnal BP (night-to-day BP ratio ≥1, sleep hypertension) is correlated with increased cardiovascular risk [28, 48, 49]. Such correlation could also be found in people with obstructive sleep apnea (OSA), whose BP rises at night while the risk of sudden cardiac death increases during sleep [31]. "
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    • "Frequently , a 10% fall has been used as a cut-off for a normal blood pressure daytime–night-time reduction. In many previous studies, a reduction in the decline in the nocturnal blood pressure has been claimed to be a risk factor for cardiovascular disease (Ingelsson et al., 2006; Izzedine et al., 2006; Fagard et al., 2008)and it also has been shown to be associated with arterial stiffness (Lekakis et al., 2005). Pre-eclampsia has been frequently found to be associated with non-dipping (Brown et al., 2001). "
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