327 REVERSE DIPPING PATTERN WAS ASSOCIATED WITH INCREASED CARDIOVASCULAR MORTALITY

Abstract

Background: Abnormal dipping pattern in ambulatory blood pressure monitoring (ABPM) is a predictor of cardiovascular risk. However, in a real world practice situation, the impact on cardiovascular mortality of abnormal dipping pattern has not been investigated enough to be considered as standard parameter. We investigated whether the abnormal dipping pattern is more related to increased cardiovascular mortality in a tertiary referral hospital setting. Design and methods: With inclusion/exclusion criteria, 481 patients were analyzed among total 720 subjects performed ABPM between 1995 and 1996 in Hanyang University Hospital, Seoul, Korea. Nocturnal blood pressure were classified as reverse dipper (n=129) with <0% fall; and 352 non-reverse dipper with ≥0% nocturnal systolic blood pressure fall. Follow up periods were 120 months. Results: Overall cardiovascular mortality incidences were 8.4% in non-reverse dippers and 20.3% in reverse dippers. And this remained significant in a Cox regression analysis after controlling for age, gender, body mass index, hypertension, diabetes mellitus, anti-hypertensive medication, history of cardiovascular disease, smoking and hypercholesterolemia. There was a tendency for reverse dippers were at greater risk than were non-reverse dippers (RR, 3.649, p=0.016). There was no difference in the event rate between dipper and non-dipper. Conclusion: Reverse dipping pattern maybe more frequent in real world clinical setting and it is strongly related to increased cardiovascular mortality.