Is daytime blood pressure adequate in cardiovascular risk assessment in patients with coronary atherosclerosis?

OBJECTIVES: The goal of our study was to estimate the impact of abnormal night-time blood pressure (BP) on cardiovascular (CV) mortality in hypertensive patients with significant atherosclerosis established in coronary angiography. METHOD: We enrolled 891 patients, 63.7 ± 9.4 years of age. They were divided into patients with normal daytime BP values, and patients with abnormal daytime BP values. During a follow-up period of 4.7 years in total, all-cause mortality and both CV and non-CV mortality were assessed. RESULTS: In the group with normal daytime BP, a clinic BP value ≥ 140/90 mmHg was observed in 25.7% (n = 161) of patients, and a night-time BP value ≥ 120/70 mmHg was observed in 37.8% (n = 236) of patients. In the group of patients with normal daytime BP in comparison with those with abnormal daytime BP, there was lower CV mortality (5.6% vs 9.8%, p < 0.02). Abnormal daytime BP was associated with a hazard ratio of CV mortality of 1.80 (95% CI 1.08-3.00, p < 0.02), and abnormal night-time BP with a hazard ratio of 1.63 (95% CI 1.03-2.66, p < 0.04). CONCLUSION: Assessment of both daytime and night-time BP is essential and superior over clinic BP in CV risk evaluation in patients with coronary artery disease confirmed in coronary angiography.