Abstract
Objective: It is known that the non dipping pattern of systolic blood pressure (ND) circadian rhythm determined by ambulatory blood pressure monitoring (ABPM) is a predictor of cardiovascular (CV) events. However it is not known if changing to a dipper pattern changes the CV prognosis. Methods: Retrospective observational analysis of hypertensive outpatients who repeated ABPM during the period of 1994 until 2013. Follow-up was defined from first appointment to 31st of December 2014 or cardiovascular event (CV) (acute coronary syndrome, stroke, heart failure or arrhythmia and sudden death). Design and method: 226 patients were included, 181 female (48,9%), mean age 56,4+/− 16,4 years. Each patient had at least 2 ABPM in a total of 634 ABPM. During a mean follow-up of 4,7 +/−1.37 years, 28 patients (7,6%) had CV event and there were 16 deaths (37,5% cardiovascular). When comparing patients with vs. without events, patients with events were older (69,0+/−13,4 vs. 55,4 +/− 16,2 years p < 0,01), had higher 24 h SBP (136,8+/− 15,6 vs. 129,8+/− 12,4 mmHg; p 0,005) and casual diastolic blood pressure (DBP) (82,6+/− 17,2 vs. 89,0+/−13,6 mmHg: p 0,02) but lower 24 h DBP (71,3+/− 11,0 vs. 75,5+/− 9,8 mmHg; p 0,03). Nocturnal fall of SBP was less pronounced in patients with events (5,9+/− 9,4 vs. 10,5+/− 7,5 mmHg; p 0,03). Analyzing the SBP pattern of nocturnal fall, in 52,7% of ABPM the pattern remained the same. When we selected only patients with a ND pattern in the initial ABMP, the Kaplan Meier free of events survival curves showed that, comparing those who stayed ND with those who changed to dipper (D) and to reverted dipper (RD), those who changed to D had significantly less CV events then those who remained ND and those who changed to RD (log rank 6,2 p < 0,05). Conclusion: In our study the modification from ND to D vs the persistence of ND is associated with less CV events. These results suggest that SBP nocturnal dipping is not only a static marker of CV risk but can undergo therapeutic intervention to improve prognosis.
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