Key result
A diary-based riser nocturnal blood pressure pattern was associated with a higher risk of cardiovascular death compared with a dipper pattern (HR 2.31; 95% CI 1.47-3.62).
Why the study?
Do fixed-clock intervals for defining nocturnal blood pressure decline predict long-term cardiovascular risk as effectively as diary records in a general population?
Cohort (n=1,714)
No
Do fixed-clock intervals for defining nocturnal blood pressure decline predict long-term cardiovascular risk as effectively as diary records in a general population?
Standard and 2h-early shifted fixed-clock intervals are feasible alternatives to diary records for defining nocturnal BP decline to predict long-term cardiovascular risk.
Answers are grounded in this paper and cite their sources.
Riser nocturnal BP pattern signals higher CV death risk in cohort data; leaves open optimal monitoring method for risk stratification.
A diminished nocturnal decline in blood pressure (BP) represents a risk factor for cardiovascular disease. To define daytime and nighttime ambulatory BP, clock time-dependent methods are used when information on diary-based sleeping time is unavailable. We aimed to compare fixed-clock intervals with diary records to identify nocturnal BP declines as a predictor of long-term cardiovascular risk among the general population. Data were obtained from 1714 participants with no history of cardiovascular disease in Ohasama, Japan (mean age, 60.6 years; 64.9% women). We defined extreme dippers, dippers, non-dippers, and risers as nocturnal systolic BP decline ≥20%, 10-19%. 0-9%, and <0%, respectively. Over a mean follow-up period of 17.0 years, 206 cardiovascular deaths occurred. Based on diary records, multivariable-adjusted hazard ratios (HRs) for cardiovascular death compared with dippers were 1.24 (95% confidence interval [CI], 0.82-1.87) in extreme dippers, 1.21 (0.87-1.69) in non-dippers, and the highest HR of 2.31 (1.47-3.62) was observed in risers. Using a standard fixed-clock interval (daytime 09:00-21:00; nighttime 01:00-06:00), a nighttime 2 h-early shifted fixed-clock (daytime 09:00-21:00; nighttime 23:00-04:00), or a nighttime 2 h-late shifted fixed-clock (daytime 09:00-21:00; nighttime 03:00-08:00), the HR (95%CI) in risers compared with dippers was 1.57 (1.08-2.27), 2.02 (1.33-3.05), or 1.29 (0.86-1.92), respectively. Although use of diary records remains preferable, the standard and nighttime 2 h-early shifted fixed-clock intervals appear feasible for population-based studies.
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Satoh et al. (2017) conducted a cohort in General population with no history of cardiovascular disease (n=1,714). Diary-based riser nocturnal blood pressure pattern vs. Diary-based dipper nocturnal blood pressure pattern was evaluated on Cardiovascular death (HR 2.31, 95% CI 1.47-3.62). A diary-based riser nocturnal blood pressure pattern was associated with a higher risk of cardiovascular death compared with a dipper pattern (HR 2.31; 95% CI 1.47-3.62).
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