It's known that nighttime values of 24-h ambulatory BP (ABP) are the more predictive for CV events. It is not settled. The aim was to evaluate which nighttime values are the more predictive for cardiovascular events (CV) strokes (STK) and coronary events (DC).Design and method:
Casual and ABP were obtained in 1200 hypertensive patients (HTA,645 female) ageing 51 ± 12 years, BMI 27 ± 5 Kg/m2, 24 systolic blood pressure 133,3 ± 16 mmHg, under stabilized therapy without previous cardiovascular (CV) events. Presence or absence of CV events were followed 11,8 ± 5,1 yearsResults:
There were 133 deaths, 251 cardiovascular fatal and non-fatal events (147 STK, 67 DC, 37 other CV events) during 21,2 years of follow-up (11,8 ± 5,1 years). After adjustment for age, BMI, gender, casual BP, antihypertensive treatment and diabetes, the nighttime values of SBP where the most predictive for global CV, stroke and coronary events, respectively HR 1,02 (95% CI 1,01–1,02; p 0.000), HR 1,02 (95% CI 1,01–1,02; p 0.000), HR 1,03 (95% CI 1,01–1,05;p < 0.05). If in the same Cox model adjusted for confounding variables such as night SBP, PP, SBP dipping, only nighttime SBP is predictive for CV events, stroke, respectively HR 1,02 (95% CI 1,00–1,04; p < 0,02); HR 1.02 (95% CI 1,00 – 1,04; p < 0,05). For DC, in the Cox analysis, night SBP analyzed in the same model with SBP dipping, only night SBP remained significant HR 1,03 (95% IC 1,00 – 1,05; p < 0,05). In survival curves of Kaplan Meier free of events 24 h PP > 60 mmHg has the worst prognostic value compared for those with 24 h PP < 60 mmHg for CV events (log rank 41,1 p 0,000) Stroke (log rank 41,8 p 0,000) and for DC (log rank 9,1 p < 0,01).Conclusions:
In our prospective study of patients with hypertension, night SBP has the highest predictive value for CV events, stroke and DC, above the other data from ABP. Also 24 h PP is a predictor of survival for CV, STK and DC.