A blunted nocturnal blood pressure decline is associated with all-cause and cardiovascular mortality
Alejandro de la Sierra, Natalie Staplin, Luis M. Ruilope, Manuel Gorostidi, Ernest Vinyoles, Julián Segura, Colin Baigent, Bryan Williams- Cardiology and Cardiovascular Medicine
- Physiology
- Internal Medicine
Objective:
It has been suggested that a blunted nocturnal blood pressure (BP) decline is associated with a poor prognosis. Nevertheless, it remains unclear if an abnormal dipping is deleterious
Methods:
Vital status and cause of death were obtained from death certificates in 59 124 patients, enrolled in the Spanish ABPM Registry between 2004 and 2014 (median follow-up: 10 years). The association between night-to-day ratio (NDR) and dipping patterns (extreme dippers, dippers, reduced dippers, and risers) with all-cause and cardiovascular mortality were evaluated by Cox-proportional models adjusted for clinical confounders and 24 h blood pressure.
Results:
NDR was associated with all-cause mortality [hazard ratio for 1SD change: 1.15; 95% confidence interval (CI) 1.13–1.17]. Reduced dippers (1.13; 1.06–1.20) and risers (1.41; 1.32–1.51) were associated with an increased risk of all-cause death, whereas extreme dippers (0.90; 0.79–1.02) were not. Elevated NDR (≥0.9) in the absence of elevated night SBP (<120 mmHg) was associated with an increased risk of death (1.13; 1.04–1.22), as well as elevated night SBP but normal NDR (1.38; 1.26–1.50), and the combination of both abnormalities (1.56; 1.46–1.66). Similar results were obtained for cardiovascular mortality.
Conclusion:
Abnormalities in the circadian pattern are associated with an increased risk of all-cause and cardiovascular mortality. This is maintained even in the absence of nocturnal BP elevation.