The Prognostic Effect of Circadian Blood Pressure Pattern on Long-Term Cardiovascular Outcome is Independent of Left Ventricular Remodeling.

Marijana Tadic,Goran Stankovic,Cesare Cuspidi,Guido Grassi,Biljana Pencic,Branislava Ivanovic,Vera Celic,Giuseppe Mancia

doi:10.3390/jcm8122126

Abstract

We aimed to investigate the predictive value of 24 h blood pressure (BP) patterns on adverse cardiovascular (CV) outcome in the initially untreated hypertensive patients during long-term follow-up. This study included 533 initially untreated hypertensive patients who were involved in this study in the period between 2007 and 2012. All participants underwent laboratory analysis, 24 h BP monitoring, and echocardiographic examination at baseline. The patients were followed for a median period of nine years. The adverse outcome was defined as the hospitalization due to CV events (atrial fibrillation, myocardial infarction, myocardial revascularization, heart failure, stroke, or CV death). During the nine-year follow-up period, adverse CV events occurred in 85 hypertensive patients. Nighttime SBP, non-dipping BP pattern, LV hypertrophy (LVH), left atrial enlargement (LAE), and LV diastolic dysfunction (LV DD) were risk factors for occurrence of CV events. However, nighttime SBP, non-dipping BP pattern, LVH, and LV DD were the only independent predictors of CV events. When all four BP pattern were included in the model, non-dipping and reverse dipping BP patterns were associated with CV events, but only reverse-dipping BP pattern was independent predictor of CV events. The current study showed that reverse-dipping BP pattern was predictor of adverse CV events independently of nighttime SBP and LV remodeling during long-term follow-up. The assessment of BP patterns has very important role in the long-time prediction in hypertensive population.

Highlights

The influence of arterial hypertension on left ventricular (LV) structural and functional remodeling is well known [1,2]
The present study provided several important findings that deserve further discussion—(i) non-dipping and reverse dipping blood pressure (BP) patterns were related with CV events; (ii) only reverse dipping BP was independently of LV structural and functional remodeling related with adverse outcome; and (iii) nighttime systolic BP (SBP) was independently associated with CV events
This study showed some limitations. (i) We included only uncomplicated and untreated hypertensive patients, which decreases potential generalization of our findings on patients with comorbidities. (ii) Systolic BP was used for classification of circadian BP patterns which could have an influence on the final results. (iii) The lack of normotensive group is potential limitation because there was no possibility to compare outcome between hypertensive patients and initially normotensive subjects. (iv) The effect of antihypertensive therapy was not possible to determine because there are no data how therapy was changed during follow-up period. (v) Polysomnography was not performed and possibly the prevalence of sleep apnea could be higher in the study population

Summary

Introduction

The influence of arterial hypertension on left ventricular (LV) structural and functional remodeling is well known [1,2]. DD are significantly associated with cardiovascular (CV) morbidity and mortality in the hypertensive population [3,4,5,6]. Circadian blood pressure (BP) patterns have important impact on LV structural and functional changes (LVH and LV DD [7]), as well as CV outcome in hypertensive population [8]. Non-dipping BP pattern was shown as important predictor of CV morbidity and mortality [9]. Updated classification of circadian BP patterns that involves extreme and reverse dippers raised the question regarding the importance of extreme and reverse dipping

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