Abstract 13685: The Circadian Decline Rate of Blood Pressure is Closely Associated With Cardiovascular Diseases in Patients With Essential Hypertension
Objective: The abnormalities of nocturnal decline of blood pressure (BP) have been found to be predictive for heart failure, stroke and sudden death in patients with hypertension. In this study, the relationship between the circadian decline rate of BP and cardiovascular diseases in hypertensive subjects was investigated.
Methods: The nocturnal decline of systolic BP (SBP) was evaluated using 24 hours ambulatory BP monitoring (ABPM). All other hypertensive patients were excluded if they (1) were 90 years old; (2) were under antihypertensive treatment; (3) had a BP over 160/100 mmHg; (4) were night workers; (5) had acute stroke or myocardial infarction within the past 6 months; (6) had sleep apnea syndrome; (7) were diagnosed as secondary hypertension; (8) could not tolerate the ABPM; (9) had other chronic diseases. A total of 285 individuals (158 male, 127 female) were eventually included in our study. Multivariate logistic regression analyses were applied to explore the relationship between the incidences of various cardiovascular diseases and the circadian decline rate of BP.
Results: In our study, the circadian decline rate of SBP fluctuated from -14.8% to 18.2%, while 10-20% reduction of SBP is considered as normal. Interestingly, the percentage of coronary artery disease (CAD) (p<0.01), lacunar infarction (p<0.05), atherosclerotic thrombotic cerebral infarction (ATCI, p<0.05), carotid arthrosclerosis (p<0.01) and diabetes (p<0.05) in patients with abnormal nocturnal decline of BP were higher than the rest of the patients. After multivariate logistic regression analysis, the higher circadian decline rate of SBP was confirmed to be an independently protective factor for CAD (OR 0.951; 95%CI 0.916-0.989; p<0.05), lacunar infarction (OR 0.893; 95%CI 0.852-0.935; p<0.01), ATCI (OR 0.922; 95%CI 0.858-0.991; p<0.05) and carotid arthrosclerosis (OR 0.904; 95%CI 0.866-0.943; p<0.01), respectively.
Conclusions: Our study showed that the abnormal nocturnal decline rate of BP is positively associated with the incidences of cardiovascular diseases including CAD, lacunar infarction, ATCI and carotid arthrosclerosis. The circadian decline rate in ABPM may help to evaluate the cardiovascular risks in hypertensive patients in clinics.
Author Disclosures: B. Yan: None. L. Peng: None. L. Sun: None. Q. Dong: None. P. Yang: None. F. Zheng: None. H. Ong: None. Q. Xu: None. G. Wang: None.
- © 2014 by American Heart Association, Inc.