Abstract 15401: HDL-Cholesterol Determines Nocturnal Blood Pressure Decline in the Elderly with Treated Hypertension
Background: High-density lipoprotein cholesterol (HDL-C) levels have an inverse correlation with incidence of ischemic heart disease, and Framingham heart study recently showed the association between low baseline HDL-C and elevated incidence of heart failure. Moreover, HDL-C increases the production of nitric oxide. The aim of this study was to test whether HDL-C level would be associated with nocturnal blood pressure (BP) decline.
Methods: We performed 24-h ambulatory BP monitoring in 1062 patients (74.8±0.2 yrs; men, 43%) with treated hypertension. Patients were classified as non-dipper BP status by night-to-day systolic BP ratio >0.9.
Results: Mean 24-h systolic/ diastolic BPs were 131±1/ 72±1mmHg. Mean nocturnal BP decline was 3.8±0.3%, and it significantly correlated with age (r= -0.17), BNP (r= -0.15), and serum HDL-C levels (r=0.16). In the multiple linear regression analysis, HDL-C (p=0.001) was an independent determinant of nocturnal BP decline after adjustment for age, sex, BMI (body mass index), total cholesterol, triglyceride, LDL-cholesterol, and agents for dyslipidemia. In the multiple logistic regression analysis, the non-dipper hazard was 2.87 (95% confidence interval [CI], 1.95 to 4.24; p<0.001) for the lowest (HDL-C<44mg/dl) versus the highest tertile of HDL-C (≥55mg/dl), and the hazard was 1.76 (95% CI, 1.23 to 2.52; p=0.002) for the middle (≥44 and <55mg/dl) versus the highest tertile of HDL-C. Values of nocturnal BP significantly correlated with age (r=0.13), sex (r= -0.07), glomerular filtration rate (eGFR) (r= -0.15), and BNP levels (r=0.12), but not with serum lipid levels. In the multiple linear regression analysis, eGFR (p=0.001) was an independent determinant of nocturnal BP after adjustment for age, sex, BMI. Moreover, in patients with the age of ≥75 years old, HDL-C (p=0.01) was an independent determinant of nocturnal BP after adjustment for age, sex, BMI, and eGFR.
Conclusion: Low HDL-C level was associated with a blunted decrease in nocturnal BP in the elderly with hypertension. HDL-C might be a good target for prevention of heart failure in the elderly, as non-dipper BP status predicts its incidence.
- © 2011 by American Heart Association, Inc.