Circulation, Vol 88, 986-992, Copyright © 1993 by American Heart Association
P Verdecchia, G Schillaci, C Gatteschi, I Zampi, M Battistelli, C Bartoccini and C Porcellati
BACKGROUND. In essential hypertension, a blunted or absent nocturnal fall
in blood pressure (BP) may be associated with increased target organ
damage. In this case-control study, we tested the hypothesis that an
association exists between a blunted or absent nocturnal fall in BP and
future cardiovascular morbid events in patients with essential
hypertension. METHODS AND RESULTS. Case subjects were 32 hypertensive
patients with a first fatal or nonfatal major cardiovascular event who had
off-therapy ambulatory BP monitoring 1 to 5 years earlier in the context of
a registry of morbidity and mortality in hypertensive patients. Control
subjects were 49 hypertensive patients free from cardiovascular events. The
groups were matched with regard to date of baseline ambulatory BP
monitoring, age, sex, clinic systolic and diastolic BP, and daytime
ambulatory systolic and diastolic BP. At their baseline evaluation, cases
and controls did not differ, in either sex, with respect to clinic BP (men,
164/100 vs 162/99 mmHg; women, 178/96 vs 180/93 mmHg), mean daytime
ambulatory BP (men, 151/94 vs 147/95 mm Hg; women, 156/90 vs 158/89 mm Hg),
age (men, 55 vs 56 years; women, 69 vs 68 years), sex, body weight, serum
cholesterol, known duration and family history of hypertension, smoking
habits, renal function, or prevalence of diabetes. Echocardiographic left
ventricular mass, determined in a subset of patients, was greater in cases
than in controls in men (145 vs 115 g/m2, P = .038) and women (137 vs 102
g/m2, P = .032). The time interval between baseline ambulatory BP
monitoring and subsequent cardiovascular event (cases: mean, 2.1 years) or
last contact with our center (controls: mean, 2.5 years) did not differ
between the groups. In the baseline ambulatory BP profile, the nocturnal
reductions of systolic and diastolic BP in men were 9% and 11%,
respectively, in cases vs 9% and 12% in controls (all P = NS), whereas in
women they were 3% and 8% in cases vs 11% and 16% in controls (P =
.002/.004). CONCLUSIONS. This retrospective case-control study suggests an
association between the reduction or absence of the usual nocturnal fall in
BP and future cardiovascular morbid events in white women with essential
hypertension.
ARTICLES
Blunted nocturnal fall in blood pressure in hypertensive women with future cardiovascular morbid events
General Hospital R. Silvestrini, Division of Medicine, Perugia PG, Italy.
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