Increased nighttime blood pressure or nondipping profile for prediction of cardiovascular outcomes

Tsioufis, Costas; Andrikou, Ioannis; Thomopoulos, Costas; Syrseloudis, Dimitris; Stergiou, George S.; Stefanadis, Christodoulos

doi:10.1038/jhh.2010.113

Cited by 68 publications

(51 citation statements)

References 100 publications

(65 reference statements)

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“…27 One recent study showed that the nondipping pattern of nocturnal blood pressure is more common in patients with RLS compared to controls, 28 which has been suggested to be an independent risk factor for cardiovascular events. 29 Positive associations between RLS and CVD had also been consistently observed in cross-sectional studies with ORs ranging from 1.4 to 2.9. 9 In one prospective study, a significantly higher risk of coronary heart diseases (HR 1.7; 95% CI 1.1-2.6) was found among people with RLS for .3 years relative to those without RLS.…”

Section: Methods Study Population the Hpfs Was Established Inmentioning

confidence: 91%

Prospective study of restless legs syndrome and mortality among men

Wang

Winkelman

et al. 2013

Neurology

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Objective: To prospectively examine whether men with restless legs syndrome (RLS) had an increased risk of mortality.Method: This was a prospective cohort study of 18,425 US men free of diabetes, arthritis, and renal failure in the Health Professionals Follow-up Study (HPFS). In 2002, RLS was assessed using a set of standardized questions. Deaths were identified from state vital statistics records, the National Death Index, family reports, and the postal system.Results: During 8 years of follow-up (2002-2010), we documented 2,765 deaths. In an age-adjusted model, RLS was associated with a 39% increased risk of mortality (hazard ratio [HR] 5 1.39; 95% confidence interval [CI] 1.19-1.62; p , 0.0001). The association between RLS and mortality was slightly attenuated after further adjustment for body mass index, lifestyle factors, chronic conditions, sleep duration, and other sleep-related disorders (adjusted HR 5 1.30; 95% CI 1.11-1.52; p 5 0.003). When we further excluded those with major chronic conditions (e.g., cancer, high blood pressure, cardiovascular disease, and other comorbidities), the adjusted HR was 1.92 (95% CI 1.03-3.56; p 5 0.04). The interactions between RLS and other risk factors (older age, overweight, short sleep duration, smoking, low physical activity, and unhealthy diet) in relation to total mortality risk were not significant (p for interaction .0.2 for all). Conclusion:We observed that men with RLS had a higher overall mortality and this association was independent of known risk factors. The increased mortality in RLS was more frequently associated with respiratory disease, endocrine disease, nutritional/metabolic disease, and immunologic disorders. Future research exploring the pathophysiologic relationship between these disorders and RLS is warranted. Neurology Restless legs syndrome (RLS) is a bothersome chronic condition, characterized by an almost irresistible urge to move the legs and usually occurring with leg sensations of burning, creeping, tugging, or "like insects crawling inside the legs," which are worse in the evening and night with significant relief in the morning.1-3 This sensorimotor disorder was described in the late 17th century by Sir Thomas Willis and was coined RLS by Karl Ekbom in the 1940s.2 RLS affects 5%-10% of adults in the general population, 4-8 and is associated with various chronic conditions. 9A notable high mortality associated with RLS has been observed among men and women with renal disease. 10,11 In the general population, 3 previous studies 12-14 examined the association between RLS symptoms and mortality and reported inconsistent results. However, these studies are limited by small sample size, failure to employ standard questions to assess RLS, 12,13 or lack of information on RLS frequency.

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Section: Methods Study Population the Hpfs Was Established Inmentioning

confidence: 91%

Prospective study of restless legs syndrome and mortality among men

Wang

Winkelman

et al. 2013

Neurology

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“…21 The prognosis of nocturnal hypertension in treated hypertensive patients was investigated in several studies 29,30 and summarized in a systematic narrative review. 31 These studies clearly demonstrated the importance of nocturnal hypertension in the management of hypertension. However, defining nocturnal hypertension in subjects with normal clinic blood pressure, especially the isolated form, has quite different clinical implications in the identification and management of hypertension.…”

Section: Cardiovascular Disease and Mortalitymentioning

confidence: 97%

Isolated Nocturnal Hypertension

Wang

2013

Hypertension

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“…26 Perez-Lloret et al 24 in a study including 233 untreated and treated hypertensives were able to demonstrate that nocturnal hypertension defined by fixed cutoff limits recommended by the 2007 European Society of Hypertension/European Society of Cardiology 27 was a better predictor of LVH (odds ratio, 11.1; 95% CI, 3.0-40.1; P<0.001) than the nondipping pattern (odds ratio, 1.4; 95% CI, 0.4-5.5; P=NS).…”

Section: Discussionmentioning

confidence: 99%

Nighttime Blood Pressure and New-Onset Left Ventricular Hypertrophy

et al. 2013

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Extensive echocardiographic investigations performed in the past 3 decades have shown that hypertensive heart disease includes a variety of anatomic and functional alterations, such as left ventricular hypertrophy (LVH), systolic/diastolic dysfunction, myocardial fibrosis, and left atrial and aortic dilatations. [1][2][3][4][5] Among these manifestations of cardiac damage, particular attention has been devoted to LVH because this phenotype has been reported to be a powerful, independent predictor of cardiovascular (CV) events and all-cause mortality either in the general population or in hypertensive cohorts. 6,7 Although the pathogenesis of hypertensive LVH is not fully understood, a consistent body of evidence indicates that the severity of pressure overload, as better reflected by out-of-office than by in-office blood pressure (BP) levels, in combination with nonhemodynamic variables, including genetic, ethnic, and humoral factors, plays a pivotal role in its development. 8,9 Nonetheless, numerous reports have also shown that circadian variations in BP correlate to LVH independently of 24-hour ambulatory BP monitoring (ABPM) values. Furthermore, earlier studies suggested that daytime BP, in particular BP values recorded during working hours, is more closely associated with LVH compared with nighttime BP. 10 More recently, however, numerous studies have shown that nighttime BP and nocturnal BP fall are stronger correlates of LVH than daytime or average 24-hour BP. 11,12Although a blunted decrease in nighttime BP (ie, nondipping status) has been associated with unhealthy conditions, including diabetes mellitus, metabolic syndrome, sleep apnea, cardiac or extracardiac organ damage, resistant hypertension, and an increased risk of CV morbidity and mortality, 13-15 this issue remains a source of debate. It is worthy of mention that a systematic review by Hansen et al 16 which included 25 856 hypertensive patients and 9641 individuals randomly recruited from the population revealed that nondipping status and increased night-to-day BP ratio were associated with higher all-cause mortality and CV events but added a marginal prognostic value over and beyond 24-hour BP.

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Increased nighttime blood pressure or nondipping profile for prediction of cardiovascular outcomes

Cited by 68 publications

References 100 publications

Prospective study of restless legs syndrome and mortality among men

Prospective study of restless legs syndrome and mortality among men

Isolated Nocturnal Hypertension

Nighttime Blood Pressure and New-Onset Left Ventricular Hypertrophy

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