Nighttime Blood Pressure Phenotype and Cardiovascular Prognosis
Key result
A disrupted circadian blood pressure rhythm (riser pattern) was significantly associated with a higher overall cardiovascular disease risk compared with a normal circadian rhythm (HR 1.48; 95% CI 1.05-2.08; P=0.024).
Why the study?
Ambulatory and home blood pressure monitoring parameters predict cardiovascular events better than office blood pressure, but robust data and information on heart failure risk are lacking.
Do nighttime systolic blood pressure levels and a riser pattern increase the risk of cardiovascular events in patients with cardiovascular risk factors?
Population
6,359 patients with at least 1 cardiovascular risk factor free of symptomatic cardiovascular disease
Comparison
Nocturnal hypertension and nighttime BP dipping patterns assessed by 24-hour ambulatory BP monitoring
Design
Practitioner-based nationwide multicenter prospective observational study
Follow-up
Mean 4.5±2.4 years
Authors
Discussion
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Member takes
Implication
Supports ABPM for risk stratification in patients with CV factors; hypothesis-generating and leaves open whether targeting riser pattern improves outcomes.
Key Points
- To determine the association between nocturnal hypertension, circadian blood pressure dipping patterns, and subsequent cardiovascular events and heart failure in patients with hypertension.
- Nationwide, multicenter, prospective observational study (JAMP study; UMIN000020377) analyzing 6,359 hypertensive patients without symptomatic cardiovascular disease at baseline.
- Participants underwent 24-hour ambulatory blood pressure monitoring using standardized devices and diary protocols, with annual follow-up over a mean of 4.5±2.4 years.
- During follow-up, 306 cardiovascular events occurred (119 stroke, 99 coronary artery disease, 88 heart failure).
- Each 20-mm Hg increase in nighttime systolic BP was independently associated with atherosclerotic cardiovascular disease (adjusted HR 1.21 [95% CI, 1.03–1.41], P=0.017) and heart failure (adjusted HR 1.36 [95% CI, 1.08–1.71], P=0.009).
- A disrupted riser pattern (nighttime BP higher than daytime BP) significantly increased total cardiovascular risk (HR 1.48 [95% CI, 1.05–2.08], P=0.024) and heart failure risk (HR 2.45 [95% CI, 1.34–4.48], P=0.004) compared to normal dipping rhythms.
Study Design
Type
Observational (n=6,359)
Multicenter
Yes
Structured PICO
Do nighttime systolic blood pressure levels and a riser pattern increase the risk of cardiovascular events in patients with cardiovascular risk factors?
P
Population
6,359 patients with at least 1 cardiovascular risk factor, mostly hypertension, free of symptomatic cardiovascular disease, followed for a mean of 4.5 years.
E
Exposure
Nighttime systolic blood pressure and disrupted circadian BP rhythm (riser pattern) assessed via 24-hour ambulatory BP monitoring
C
Comparator
Normal circadian BP rhythm
O
Outcome
Cardiovascular events (atherosclerotic cardiovascular disease and heart failure) over a mean follow-up of 4.5 yearscomposite
Main Result
Hazard Ratio: 1.48 (95% CI 1.05–2.08)
p-value: p=0.024
Nighttime systolic blood pressure and a riser pattern on ambulatory monitoring are independent predictors of cardiovascular events, particularly heart failure, in patients with cardiovascular risk factors.
Cite This Study
Kario et al. (2020) conducted an observational in Hypertension and cardiovascular risk factors (n=6,359). Disrupted circadian BP rhythm (riser pattern) vs. Normal circadian rhythm was evaluated on Overall cardiovascular disease risk (HR 1.48, 95% CI 1.05-2.08, p=0.024). A disrupted circadian blood pressure rhythm (riser pattern) was significantly associated with a higher overall cardiovascular disease risk compared with a normal circadian rhythm (HR 1.48; 95% CI 1.05-2.08; P=0.024).