Key result
High morning surge (HR 2.45; 95% CI 1.27-4.73) and nondipping (HR 2.04; 95% CI 1.18-3.53) increased cardiovascular risk compared to normal morning surge in elderly treated hypertensives.
Why the study?
Do nondipping and high morning surge blood pressure patterns increase cardiovascular risk in elderly treated hypertensive patients with controlled ambulatory blood pressure?
Cohort (n=391)
Do nondipping and high morning surge blood pressure patterns increase cardiovascular risk in elderly treated hypertensive patients with controlled ambulatory blood pressure?
In elderly treated hypertensive patients with controlled ambulatory blood pressure, nondipping and high morning surge patterns remain significant independent predictors of adverse cardiovascular events.
Answers are grounded in this paper and cite their sources.
May aid risk stratification via ambulatory monitoring in elderly hypertensives; leaves open whether targeting surge or dipping reduces events.
BACKGROUND: The independent prognostic significance of nondipping and morning surge (MS) of blood pressure (BP) in treated hypertensive patients with controlled ambulatory BP is not yet clear. We investigated the association between the aforesaid ambulatory BP parameters and cardiovascular risk in elderly treated hypertensive patients with normal achieved ambulatory BP. METHODS: The occurrence of a composite end-point (stroke, coronary events, heart failure, and peripheral revascularization) was evaluated in 391 elderly treated hypertensive patients (age range 60-90 years) with controlled ambulatory BP (both daytime BP <135/85 mm Hg and nighttime BP <120/70 mm Hg). According to nighttime change and MS of systolic BP, subjects were divided in dippers with normal or high MS (>23 mm Hg) and nondippers. RESULTS: During the follow-up (9.3 ± 4.6 years, range 0.5-20 years), 76 events occurred. The event-rate was 2.09 per 100 patient-years. After adjustment for age, gender, left ventricular (LV) hypertrophy, asymptomatic LV systolic dysfunction at baseline and left atrial enlargement, dippers with high MS (hazard ratio 2.45, 95% confidence interval 1.27-4.73, P = 0.007) and nondippers (hazard ratio 2.04, 95% confidence interval 1.18-3.53, P = 0.01) were at higher cardiovascular risk than dippers with normal MS. CONCLUSIONS: In elderly treated hypertensive patients with normal achieved ambulatory BP, dippers with high MS and nondippers are at increased cardiovascular risk.
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Pierdomenico et al. (2016) conducted a cohort in Hypertension (n=391). High morning surge or nondipping blood pressure vs. Dippers with normal morning surge was evaluated on Composite end-point (stroke, coronary events, heart failure, and peripheral revascularization) (HR 2.45, 95% CI 1.27-4.73, p=0.007). High morning surge (HR 2.45; 95% CI 1.27-4.73) and nondipping (HR 2.04; 95% CI 1.18-3.53) increased cardiovascular risk compared to normal morning surge in elderly treated hypertensives.
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