The 24-h blood pressure measurement may predict mortality and cardiovascular events in hypertensive patients with coronary artery disease

The aim of this prospective study was to evaluate the relationship between 24-h blood pressure (BP) values and cardiovascular events in hypertensive patients with coronary artery disease in the long-term observation. Two hundred and seventy-four patients (mean age 56.9+/-9.3 years, 197 male, 77 female) who underwent coronary and renal angiography were investigated. Baseline characteristics included clinical and biochemical evaluations, 24-h BP measurement and standardized auscultatory readings - clinic BP. The composite end-point of death from all causes, nonfatal acute myocardial infarction, coronary revascularization and stroke were assessed at mean 40 months follow-up. Patients with the composite end-point had higher mean 24-h systolic BP (SBP) and diastolic BP (DBP) levels (124/74 vs. 117/71 mmHg; P<0.001 and P<0.05 for SBP and DBP, respectively), higher mean daytime SBP and DBP (127/76 vs. 119/72 mmHg; P<0.001 and P<0.05 for SBP and DBP, respectively) and higher night-time SBP and DBP (121/69 vs. 111/65 mmHg; P<0.001 and P<0.05 for SBP and DBP, respectively) at baseline. There were no differences in systolic and diastolic clinic BP levels between patients with and without the combined end-point. Multivariate Cox model revealed that only a number of coronary arteries stenosed and 24-h systolic BP level were independent predictors of occurrence of the composite end-point. In conclusion, our results indicate that 24-h BP measurement made in hospital but not the clinic standardized auscultatory readings predicts cardiovascular risk.