Day-night dip and early-morning surge in blood pressure in hypertension: prognostic implications

Hypertension
P VerdecchiaGianpaolo Reboldi

Abstract

We investigated the relationship between the day-night blood pressure (BP) dip and the early morning BP surge in an cohort of 3012 initially untreated subjects with essential hypertension. The day-night reduction in systolic BP showed a direct association with the sleep trough (r = 0.564; P < 0.0001) and the preawakening (r = 0.554; P < 0.0001) systolic BP surge. Over a mean follow-up period of 8.44 years, 268 subjects developed a major cardiovascular event (composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, and heart failure requiring hospitalization) and 220 subjects died. In a Cox model, after adjustment for predictive covariates, including age, sex, diabetes mellitus, cigarette smoking, total cholesterol, left ventricular hypertrophy on ECG, estimated glomerular filtration rate, and average 24-hour systolic BP, a blunted sleep trough (≤ 19.5 mm Hg; quartile 1) and preawakening (≤ 9.5 mm Hg; quartile 1) BP surge was associated with an excess risk of events (hazard ratio, 1.66 [95% CI, 1.14-2.42]; P = 0.009; hazard ratio, 1.71 [95% CI, 1.12-2.71]; P = 0.013). After adjustment for the same covariates, neither the dipping pattern nor the measures of early morning BP surge were independent predic...Continue Reading

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Citations

Jul 11, 2013·Current Treatment Options in Cardiovascular Medicine·Amita SinghHoward Weintraub
Nov 17, 2012·Hypertension Research : Official Journal of the Japanese Society of Hypertension·Mai YanagiSatoshi Umemura
Sep 21, 2013·Hypertension Research : Official Journal of the Japanese Society of Hypertension·Philippe Gosse, Helmut Schumacher
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