Non-Dipping Pattern Is Associated with Periprocedural Myocardial Infarction in Hypertensive Patients Undergoing Elective Percutaneous Coronary Intervention

Background and Objectives: Non-dipping blood pressure (BP) patterns are associated with increased cardiovascular risk, but their role in periprocedural myocardial infarction (PMI) during elective percutaneous coronary intervention (PCI) remains insufficiently clarified. The objective was to investigate whether a non-dipping BP profile independently predicts PMI in hypertensive patients undergoing elective PCI. Materials and Methods: This prospective observational study enrolled 462 hypertensive patients undergoing elective PCI, categorized as dipping or non-dipping based on 24 h ambulatory BP monitoring (ABPM). Clinical, laboratory, and angiographic data were compared. PMI was defined according to the Fourth Universal Definition of Myocardial Infarction. Independent predictors of PMI were identified using multivariate logistic regression. Results: Of the 462 patients, 243 (52.6%) exhibited a non-dipping BP pattern. Non-dipping status was significantly associated with higher incidence of PMI (32.5% vs. 13.7%, p < 0.001) and a worse metabolic profile, including elevated blood glucose (p = 0.001), Hemoglobin A1c (p = 0.002), and white blood cell count (p = 0.001), and lower high-density lipoprotein cholesterol (p = 0.047). These patients more frequently underwent complex PCI (25.1% vs. 5.0%, p < 0.001). In multivariate analysis, the non-dipping BP pattern emerged as the strongest independent predictor of PMI (odds ratio 25.99, 95% confidence interval 3.16–213.92, p = 0.002), followed by complex PCI, number of stents, stent length, and diabetes mellitus. Conclusions: Non-dipping BP pattern is a powerful and independent predictor of PMI in hypertensive patients undergoing PCI. Incorporating ABPM into routine cardiovascular risk assessment may improve the identification of high-risk patients and allow for tailored preventive strategies.