Twenty‐Four‐Hour Blood Pressure Variability Combined With Circadian Rhythm Patterns in Predicting Cardiovascular Events in Hypertensive Patients

Figures

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  FIGURE 1. Flow diagram of patient selection and study inclusion. The flowchart outlines the identification, screening, exclusion, and final inclusion of hypertensive patients who underwent 24‐hour ambulatory blood pressure monitoring between January 2019 and December 2024. After exclusion of patients with secondary hypertension, invalid ABPM recordings, advanced chronic kidney disease, arrhythmias affecting ABPM accuracy, and incomplete follow‐up data, a final cohort of 500 patients was included in the analysis.

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  FIGURE 2. Distribution of circadian blood pressure patterns among hypertensive patients. Normal dipper, extreme‐dipper, non‐dipper, and reverse‐dipper patterns were observed in 36.0%, 6.0%, 46.0%, and 12.0% of patients, respectively. For the primary analyses, normal and extreme dippers were combined into a single dipper reference group, representing 42.0% of the study population. *Non‐dipper or reverse dipper.

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  FIGURE 3. Major adverse cardiovascular event‐free survival according to 24‐hour systolic blood pressure variability. Kaplan–Meier curves compare event‐free survival between patients with low and high blood pressure variability (BPV). High BPV was defined as a 24‐hour systolic blood pressure (SBP) standard deviation greater than the study median of 13.5 mmHg, whereas low BPV was defined as a value of 13.5 mmHg or less. The vertical axis represents the estimated probability of remaining free from a major adverse cardiovascular event (MACE), and the horizontal axis represents follow‐up time. Patients with high BPV had significantly lower MACE‐free survival than those with low BPV (log‐rank P < 0.001). Abbreviations: BPV, blood pressure variability; SBP, systolic blood pressure; MACE, major adverse cardiovascular events.

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  FIGURE 4. Major adverse cardiovascular event‐free survival according to circadian blood pressure pattern. Kaplan–Meier curves compare event‐free survival among patients classified as dippers, non‐dippers, or reverse dippers according to the percentage decline in nighttime systolic blood pressure relative to daytime systolic blood pressure. The dipper reference group included both normal dippers, with a nocturnal SBP decline of 10% to < 20%, and extreme dippers, with a nocturnal SBP decline of ≥ 20%. Non‐dippers had a nocturnal SBP decline of 0% to < 10%, whereas reverse dippers had nighttime SBP values higher than daytime values. The vertical axis represents the estimated probability of remaining free from MACE, and the horizontal axis represents follow‐up time. Reverse dippers had the lowest MACE‐free survival, followed by non‐dippers, while the combined dipper group had the most favorable outcome (log‐rank P < 0.01). Abbreviations: SBP, systolic blood pressure; MACE, major adverse cardiovascular events.

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  FIGURE 5. Multivariable predictors of cardiovascular events.