Abstract
Introduction: Nondipper patterns of pulse rate (PR) as well as blood pressure (BP) have been associated with cardiovascular events. High night PR is also associated cardiovascular events. Hypothesis: We assessed the hypothesis that a nondipper PR pattern was independently associated with cardiovascular events in patients with cardiovascular risk factors, adjusting for night pulse rate. Methods: Ambulatory BP monitoring was conducted at baseline in 1443 patients who had one or more cardiovascular risk factors. PR nondipping status was defined as (awake PR - sleep PR)/awake PR < 0.1. Results: The nondipper PR patients (N=339) were older (66.8±10.6 vs. 63.9±11.8, p<0.001) and had a higher night PR (65.5±9.6 vs. 58.9±7.3/min, p<0.001) than the dipper PR patients (N=1104). The mean follow-up period was 60±30 months; in that time 50 patients (4.5%) in the dipper PR group and 34 patients (10.0%) in the nondipper PR group suffered primary endpoints (log rank 22.2, p<0.001). On the Cox proportional hazards model including age, gender and night systolic blood pressure, nondipper PR was an independent predictor of cardiovascular event (hazard ratio 2.38, 95% confidence interval 1.51-3.74, p<0.001), but night PR was not (p=0.50). We analyzed four groups according to BP and PR dipping status, the combination of nondipper BP and nondipper PR constituted a higher risk of cardiovascular events and stroke than the sum of the other three combination risks (Log rank= 39.2, p<0.001, figure). When we added the nondipper BP pattern in the model, nondipper PR remained an independent predictor of cardiovascular events (hazard ratio 2.29, 95% confidence interval 1.50-3.51, p<0.001). After excluding patients who took beta blockers (N=1003), nondipper PR was an independent predictor of cardiovascular events (hazard ratio 2.16, 95% confidence interval 1.22-3.82, p=0.008). Conclusions: The nondipper PR pattern was associated with cardiovascular events, but night pulse rate was not.
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