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Elevated nighttime systolic blood pressure (BP) and a disrupted circadian pattern for BP are associated with an increased risk for certain cardiovascular events, such as heart failure, according to a study published online Nov. 2 in Circulation.
Kazuomi Kario, M.D., Ph.D., from the Jichi Medical University School of Medicine in Shimotsuke, Japan, and colleagues conducted a nationwide prospective, observational study involving 6,359 patients with at least one cardiovascular risk factor and free of symptomatic cardiovascular disease at baseline. Patients were followed annually for primary cardiovascular end points (atherosclerotic cardiovascular disease and heart failure).
The researchers identified 306 cardiovascular events during a mean follow-up of 4.5 ± 2.4 years. After adjustment for demographic and clinical risk factors, there was a significant association seen for nighttime systolic BP with the risk for atherosclerotic cardiovascular disease and heart failure (hazard ratios per 20-mm Hg increase, 1.18 [95 percent confidence interval (CI), 1.02 to 1.37; P = 0.029] and 1.25 [95 percent CI, 1.00 to 1.55; P = 0.048], respectively). Compared with normal circadian rhythm, there was a significant association noted for disrupted circadian BP rhythm (riser pattern, nighttime BP higher than daytime BP) with higher overall cardiovascular disease risk and heart failure (hazard ratios, 1.48 [95 percent CI, 1.05 to 2.08; P = 0.024] and 2.45 [95 percent CI, 1.34 to 4.48; P = 0.004], respectively).
"Results indicate that nighttime systolic blood pressure was a significant, independent risk factor for cardiovascular events," Kario said in a statement. "The study highlights the importance of including nighttime blood pressure monitoring in patient management strategies and will hopefully encourage physicians to ensure that antihypertensive therapy is effectively lowering blood pressure throughout the 24-hour dosing period."
One author disclosed financial ties to the medical device industry.
Physician's Briefing Staff
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