Prognostic Effect of the Nocturnal Blood Pressure Fall in Hypertensive Patients: The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) Meta-Analysis

The prognostic importance of the nocturnal systolic blood pressure (SBP) fall, adjusted for average 24-hour SBP levels, is unclear. The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) examined this issue in a meta-analysis of 17 312 hypertensives from 3 continents. Risk...

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Veröffentlicht in:Hypertension (Dallas, Tex. 1979) Tex. 1979), 2016-04, Vol.67 (4), p.693-700
Hauptverfasser: Salles, Gil F, Reboldi, Gianpaolo, Fagard, Robert H, Cardoso, Claudia R.L, Pierdomenico, Sante D, Verdecchia, Paolo, Eguchi, Kazuo, Kario, Kazuomi, Hoshide, Satoshi, Polonia, Jorge, de la Sierra, Alejandro, Hermida, Ramon C, Dolan, Eamon, O’Brien, Eoin, Roush, George C
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Sprache:eng
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Zusammenfassung:The prognostic importance of the nocturnal systolic blood pressure (SBP) fall, adjusted for average 24-hour SBP levels, is unclear. The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) examined this issue in a meta-analysis of 17 312 hypertensives from 3 continents. Risks were computed for the systolic night-to-day ratio and for different dipping patterns (extreme, reduced, and reverse dippers) relative to normal dippers. ABC-H investigators provided multivariate adjusted hazard ratios (HRs), with and without adjustment for 24-hour SBP, for total cardiovascular events (CVEs), coronary events, strokes, cardiovascular mortality, and total mortality. Average 24-hour SBP varied from 131 to 140 mm Hg and systolic night-to-day ratio from 0.88 to 0.93. There were 1769 total CVEs, 916 coronary events, 698 strokes, 450 cardiovascular deaths, and 903 total deaths. After adjustment for 24-hour SBP, the systolic night-to-day ratio predicted all outcomesfrom a 1-SD increase, summary HRs were 1.12 to 1.23. Reverse dipping also predicted all end pointsHRs were 1.57 to 1.89. Reduced dippers, relative to normal dippers, had a significant 27% higher risk for total CVEs. Risks for extreme dippers were significantly influenced by antihypertensive treatment (P
ISSN:0194-911X
1524-4563
DOI:10.1161/HYPERTENSIONAHA.115.06981