Prognostic value of asleep and awake blood pressure for cardiovascular risk assessment according to gender: the Hygia Project

Abstract

treatment was adjusted based on ABPM) thereafter, ambulatory BP and physical activity (wrist actigraphy) were simultaneously monitored for 48h to accurately derive the awake and asleep BP means. The Cox proportional-hazard model, adjusted for significant confounding variables, was used to estimate hazard ratios (HR) for the risk of developing diabetes associated with sleep-time-relative BP decline and dipping classification. During a 5.6-year median follow-up, 190 participants developed diabetes. The diminished sleep-time relative BP decline was a highly significant predictor of new-onset diabetes in a Cox proportional-hazard model adjusted for the significant influential variables of age, waist perimeter, glucose, and chronic kidney disease (for each 1-SD elevation, HR1⁄40.77, [95%CI: 0.680.88], P<0.001). Based on the baseline ABPM evaluation per participant, the adjusted HR was similar in extreme-dippers and dippers (P1⁄40.882), but significantly greater in non-dippers (P1⁄40.002) and risers (P<0.001). Based on the data of the last 48h ABPM profile per participant, compared to dippers the adjusted HR of new-onset diabetes was lower in extremedippers (P1⁄40.029) and significantly higher in non-dippers and risers (P<0.001). The risk of developing diabetes decreased in extreme-dippers during follow-up, in which nighttime hypotension was avoided by proper use of ABPM-based pharmacotherapy. The HR of new-onset diabetes was significantly greater in non-dippers and, to a larger extent in risers. Results seem to indicate a blunted sleep-time relative BP decline predicts, rather than being a consequence, the development of diabetes.