Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study

Boggia, José; Li, Yan; Thijs, Lutgarde; Hansen, Tine W.; Kikuya, Masahiro; Björklund-Bodegård, Kristina; Richart, Tom; Ohkubo, Takayoshi; Kuznetsova, Tatiana; Torp‐Pedersen, Christian; Lind, Lars; Ibsen, Hans; Imai, Yutaka; Wang, Ji‐Guang; Sandoya, Edgardo; O’Brien, Eoin; Staessen, Jan A.

doi:10.1016/s0140-6736(07)61538-4

Cited by 770 publications

(456 citation statements)

References 53 publications

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“…Individuals with a non-dipper pattern (reduction in nighttime SBP o10%) are at increased risk for cerebrovascular and cardiovascular complications Nocturnal dipping and endothelial function in resistant hypertension T Quinaglia et al when compared with individuals with a normal dipper profile. 16,[21][22][23][24][25][26] Previous studies have shown that patients with UCRH and CRH both have blunted nocturnal drops in SBP and DBP. 3,27 In these earlier publications, patients with RHTN have a high prevalence of nondipper pattern which contributes to an increased risk of cardiovascular events, 18 as well as a high prevalence of target organ damage at cardiac, macroand microvascular levels.…”

Section: Discussionmentioning

confidence: 99%

Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

et al. 2011

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Resistant hypertension (RHTN) includes both patients whose blood pressure (BP) is uncontrolled on three or more medications (uncontrolled RHTN (UCRH)) and patients whose BP is controlled with use of four or more drugs (controlled RHTN (CRH)). It is unknown whether endothelial function and nocturnal drop demonstrate a similar pattern in patients with CRH and UCRH. We examined circadian BP patterns and vascular function in these patients. In all, 40 CRH and 26 UCRH patients, and 25 normotensives underwent biochemical testing, ambulatory BP monitoring, determination of brachial artery responses to endothelial-dependent (flow-mediated; dilation (FMD)) and independent (nitroglycerin mediated) stimuli. The nighttime drop in systolic BP (SBP) and diastolic BP (DBP) was less pronounced in UCRH than in CRH (SBP, 1.9±1.6 versus 4.9 ± 1.7%; DBP, 7.5 ± 1.8 versus 10.9 ± 1.8%, UCRH and CRH, respectively; Po0.05). FMD was greater in control group compared with RHTN patients. Patients with UCRH had significantly impaired FMD compared with CRH (5.9 ± 2.3% versus 7.1 ± 5.1%; Po0.0001). Therefore, UCRH patients have less nocturnal dipping and a more impaired endothelial response compared with CRH patients. These findings suggest that important differences among patients with RHTN may allow identify subgroups with increased cardiovascular risk.

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Section: Discussionmentioning

confidence: 99%

Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

et al. 2011

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“…Thus, this study suggests that home blood pressure measurement may be a suitable alternative if a correct blood pressure target is chosen, but more studies are needed before home blood pressure can be recommended for antihypertensive treatment titration. Finally, it has to be emphasized that in contrast to home blood pressure measurement, 24-h blood pressure measurement can give additional important information about night-time blood pressure, 9 dipping status [26][27][28] or 24-h blood pressure variability, 13 all of which may lead to improved risk stratification of individuals with hypertension. On the other hand, potential drawbacks of 24-h blood pressure measurement include additional costs and patient discomfort.…”

Section: Discussionmentioning

confidence: 99%

Twenty-four hour ambulatory blood pressure for the management of antihypertensive treatment: a randomized controlled trial

2008

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The aim of this study was to assess whether the use of 24-h blood pressure (BP) measurement in the management of antihypertensive therapy improves BP in patients with sustained hypertension. Patients with sustained hypertension (office BP X140/90 mm Hg, and 24-h systolic BP X130/80 mm Hg) were randomly assigned to a strategy using 24-h BP to manage antihypertensive treatment (target o130/80 mm Hg) or to a standard strategy using office BP (target o140/90 mm Hg). The primary end point was change in 24-h systolic BP at 1 year of follow-up. We included 136 patients in the primary analysis. After 1 year of follow-up, the change in 24-h systolic BP was significantly greater in the ambulatory BP group compared with the office BP group (mean difference (95% confidence interval) À3.6 (À7.0, À0.3), P ¼ 0.03). Intentionto-treat analysis revealed essentially unchanged results.The mean number of antihypertensive drugs per participant at 1 year of follow-up was 1.76 ± 1.1 and 1.95 ± 0.9 in the ambulatory and office BP group, respectively (P ¼ 0.049). The benefit of ambulatory BP monitoring was mainly seen in patients with previously known hypertension (mean difference À7.2 (À11.6, À2.8), P ¼ 0.002), but not in those with newly detected hypertension (mean difference 0.2 (À4.9, 5.4), P ¼ 0.93). In conclusion, using 24-h BP for the management of antihypertensive therapy in patients with sustained hypertension leads to a greater BP reduction compared with a standard treatment strategy using office BP, although fewer antihypertensive drugs were used in the ambulatory BP group.

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“…Such differences in the clinical implications of nocturnal BP vs. daytime BP were more prominent in treated hypertensive patients, as shown by another meta-analysis of an International Database on Ambulatory BP in relation to Cardiovascular Outcome (IDACO; n¼7458, mean age, 57 years), indicating that daytime BP was no longer a significant predictor of cardiovascular events after adjustment for nighttime BP in treated hypertensive patients. 18 Surprisingly, the lower daytime BP was associated with increased risk of total mortality in treated hypertensive patients. These findings indicate that during treatment with antihypertensive medications, it may be necessary to assess nocturnal BP levels rather than daytime BP in order to identify individuals most likely to develop CVD.…”

Section: How To Evaluate Nocturnal Bpmentioning

confidence: 98%

“…Nevertheless, increasing evidence suggests that nocturnal BP is the more sensitive predictor of CVD outcomes than either daytime or 24-hour BP, and thus nocturnal BP measurement is becoming an important part of clinical practice. [1][2][3][4][17][18][19][20] NOCTURNAL BP AND CARDIOVASCULAR RISK A recent systematic review of 23 856 hypertensive patients and 9641 subjects from population cohorts from Asia, Europe and South America by Hansen et al 20 revealed that nocturnal BP is a significant risk factor for mortality and cardiovascular morbidity in both hypertensive patients and the general population, even when adjustments were made for daytime BP. The hazard ratios associated with each 10-mm Hg increase in nocturnal systolic BP were 1.16 or 1.14 for total mortality and 1.19 or 1.15 for cardiovascular morbidity in hypertensive patients or the general population, respectively (both Po0.001).…”

Section: How To Evaluate Nocturnal Bpmentioning

confidence: 99%

“…[25][26][27] Furthermore, certain prospective studies have shown that each 5% attenuation in the nocturnal BP decline conferred a B20% increase in the risk of cardiovascular mortality in the general or hypertensive population. 18,19,28 Recently, Muxfeldt et al 29 revealed that patients without nocturnal dipping in resistant hypertension had twofold higher risk of cardiovascular morbidity and mortality than those with dippers, in which association was independent from office and 24-hour BP level, and other cardiovascular risk factors. However, overall, the prognostic values of nondipping were inconsistent; the reasons may in part be explained by the arbitrary and varying definition of nondipping, poor reproducibility, differences in the study population or differences in the adjusted factors used in each study.…”

Section: Nocturnal Bp Dipping and Cardiovascular Riskmentioning

confidence: 99%

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Nocturnal blood pressure and cardiovascular disease: a review of recent advances

2012

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The accurate measurement, prediction and treatment of high blood pressure (BP) are essential issues in the management of hypertension. Ambulatory blood pressure monitoring (ABPM) has been shown to be superior to clinic BP measurements as ABPM can provide the following important information: (i) the mean BP levels, (ii) the diurnal variation in BP and (iii) the short-term BP variability. Among these parameters, there is increasing evidence that the mean nocturnal BP level is the most sensitive predictor of cardiovascular morbidity and mortality. Furthermore, several studies have shown that less nocturnal BP dipping, defined as less nocturnal BP decline relative to daytime BP, or a high night-day BP ratio was associated with poor prognosis irrespective of the 24-hour BP levels. These findings can be interpreted in at least two ways: namely, high nocturnal BP or less nocturnal BP dipping might be not only a potent risk factor for cardiovascular disease (CVD), but also a marker of pre-existing or concurrent diseases that can lead to nocturnal BP elevation. In this review, we consider the clinical utility of ABPM and in particular focus on the nocturnal BP levels or nocturnal BP dipping as a potent risk factor for CVD. In addition, the clinical management of high nocturnal BP and blunted nocturnal BP dipping with antihypertensive medications is discussed.

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Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study

Cited by 770 publications

References 53 publications

Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension

Twenty-four hour ambulatory blood pressure for the management of antihypertensive treatment: a randomized controlled trial

Nocturnal blood pressure and cardiovascular disease: a review of recent advances

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