What is the clinical evidence from this study?

Study design: Observational. Population: Hypertensive patients at high risk for myocardial injury after noncardiac surgery (n=40). Intervention: Nondipping blood pressure pattern vs. Dipping blood pressure pattern. Primary outcome: Perioperative change in high-sensitivity cardiac troponin T (95% CI 1.0 to 9.0, p=0.008).

What question did this study set out to answer?

This study aims to explore the association between nondipping blood pressure patterns and myocardial injury following noncardiac surgery.

April 22, 2026Open Access

Nondipping Blood Pressure Pattern Is Associated with the Development of Myocardial Injury after Noncardiac Surgery: A Single-center Prospective Observational Study

Key Result

A nondipping blood pressure pattern was associated with a greater perioperative increase in troponin T (7.0 vs 2.0 ng/l; P=0.008) and higher incidence of myocardial injury (59% vs 13%; OR 8.9).

Key Points

This study aims to explore the association between nondipping blood pressure patterns and myocardial injury following noncardiac surgery.
Enrolled 40 hypertensive patients identified as dippers or nondippers based on 24-h blood pressure monitoring.
Measured preoperative high-sensitivity cardiac troponin T and assessed the incidence of myocardial injury post-surgery.
Conducted multiple linear regression to identify factors predicting cardiac troponin T elevation.
Nondippers showed a significant increase in high-sensitivity cardiac troponin T compared to dippers, with medians of 7.0 vs. 2.0 ng/l.
The frequency of myocardial injury was higher in nondippers (59%) compared to dippers (13%).
Nondipping pattern, apnea-hypopnea index, and low intraoperative arterial pressure were identified as independent predictors of troponin T increase.

Study Design

Type

Observational (n=40)

Multicenter

Structured PICO

Does a nondipping blood pressure pattern increase perioperative change in high-sensitivity cardiac troponin T and incidence of myocardial injury in hypertensive patients undergoing noncardiac surgery?

Population

40 hypertensive patients at high risk for myocardial injury after noncardiac surgery

Intervention

Nondipping nocturnal blood pressure pattern (based on 24-h blood pressure monitoring)

Comparator

Dipping nocturnal blood pressure pattern

Outcome

Perioperative change in high-sensitivity cardiac troponin Tsurrogate

A nondipping nocturnal blood pressure pattern is significantly associated with increased perioperative myocardial injury in high-risk hypertensive patients undergoing noncardiac surgery.

Main Result

Absolute Event Rate: 7% vs 2%

p-value: p=0.008

Abstract

Background: Myocardial injury after noncardiac surgery is a common complication associated with increased morbidity and mortality. The nondipping nocturnal blood pressure pattern, reflecting sympathetic overactivity, may contribute to perioperative cardiac risk. This prospective observational study tested the hypothesis that nondippers experience greater postoperative increase in high-sensitivity cardiac troponin T and higher incidence of myocardial injury after noncardiac surgery than dippers. Methods: Based on the sample size calculation, 40 hypertensive patients at high risk for myocardial injury after noncardiac surgery were prospectively enrolled and classified as dippers or nondippers based on 24-h blood pressure monitoring. Group comparisons were performed for perioperative change in high-sensitivity cardiac troponin T (primary outcome), incidence of myocardial injury after noncardiac surgery, and postoperative complications. Multiple linear regression analysis was performed to identify independent predictors of high-sensitivity cardiac troponin T elevation. Results: Preoperative 24-h blood pressure measurements were successfully completed in all participants and identified 23 dippers (57%) and 17 nondippers (43%). Nondippers had significantly higher elevation of high-sensitivity cardiac troponin T compared with dippers (7.0 2.0 to 12.0 vs. 2.0 0.5 to 4.0 ng/l; 95% CI for the difference, 1.0 to 9.0 ng/l; P = 0.008). Myocardial injury after noncardiac surgery occurred more frequently in nondippers (59% vs. 13%; odds ratio, 8.9; 95% CI for the difference, 1.7 to 65.5; P = 0.005). Multiple linear regression analysis identified the nondipping blood pressure pattern, apnea–hypopnea index, and time-weighted average of mean intraoperative arterial pressure less than 65 mmHg as independent predictors of high-sensitivity cardiac troponin T increase (adjusted R 2 = 0.602). Conclusions: The nondipping blood pressure pattern was significantly associated with increased perioperative myocardial injury in high-risk hypertensive patients. The 24-h blood pressure monitoring may serve as a useful clinical and research tool.