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 |
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| creator | 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 |
| description | 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 |
| doi_str_mv | 10.1161/HYPERTENSIONAHA.115.06981 |
| format | Article |
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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<0.001)untreated patients had increased risk of total CVEs (HR, 1.92), whereas treated patients had borderline lower risk (HR, 0.72) than normal dippers. For CVEs, heterogeneity was low for systolic night-to-day ratio and reverse/reduced dipping and moderate for extreme dippers. Quality of included studies was moderate to high, and publication bias was undetectable. In conclusion, in this largest meta-analysis of hypertensive patients, the nocturnal BP fall provided substantial prognostic information, independent of 24-hour SBP levels.</description><identifier>ISSN: 0194-911X</identifier><identifier>EISSN: 1524-4563</identifier><identifier>DOI: 10.1161/HYPERTENSIONAHA.115.06981</identifier><identifier>PMID: 26902495</identifier><language>eng</language><publisher>United States: American Heart Association, Inc</publisher><subject>Adult ; Aged ; Antihypertensive Agents - therapeutic use ; Blood Pressure Monitoring, Ambulatory - methods ; Blood Pressure Monitoring, Ambulatory - standards ; Cardiovascular Diseases - prevention & control ; Circadian Rhythm - physiology ; Diastole - drug effects ; Diastole - physiology ; Female ; Humans ; Hypertension - drug therapy ; Hypertension - physiopathology ; Hypotension - physiopathology ; Internationality ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; Proportional Hazards Models ; Risk Assessment ; Systole - drug effects ; Systole - physiology</subject><ispartof>Hypertension (Dallas, Tex. 1979), 2016-04, Vol.67 (4), p.693-700</ispartof><rights>2016 American Heart Association, Inc</rights><rights>2016 American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4861-2bd94542585c853ed1f55500c6b75ab68d2b009645858dee3dde2170b82d006e3</citedby><cites>FETCH-LOGICAL-c4861-2bd94542585c853ed1f55500c6b75ab68d2b009645858dee3dde2170b82d006e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26902495$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Salles, Gil F</creatorcontrib><creatorcontrib>Reboldi, Gianpaolo</creatorcontrib><creatorcontrib>Fagard, Robert H</creatorcontrib><creatorcontrib>Cardoso, Claudia R.L</creatorcontrib><creatorcontrib>Pierdomenico, Sante D</creatorcontrib><creatorcontrib>Verdecchia, Paolo</creatorcontrib><creatorcontrib>Eguchi, Kazuo</creatorcontrib><creatorcontrib>Kario, Kazuomi</creatorcontrib><creatorcontrib>Hoshide, Satoshi</creatorcontrib><creatorcontrib>Polonia, Jorge</creatorcontrib><creatorcontrib>de la Sierra, Alejandro</creatorcontrib><creatorcontrib>Hermida, Ramon C</creatorcontrib><creatorcontrib>Dolan, Eamon</creatorcontrib><creatorcontrib>O’Brien, Eoin</creatorcontrib><creatorcontrib>Roush, George C</creatorcontrib><creatorcontrib>ABC-H Investigators</creatorcontrib><title>Prognostic Effect of the Nocturnal Blood Pressure Fall in Hypertensive Patients: The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) Meta-Analysis</title><title>Hypertension (Dallas, Tex. 1979)</title><addtitle>Hypertension</addtitle><description>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<0.001)untreated patients had increased risk of total CVEs (HR, 1.92), whereas treated patients had borderline lower risk (HR, 0.72) than normal dippers. For CVEs, heterogeneity was low for systolic night-to-day ratio and reverse/reduced dipping and moderate for extreme dippers. Quality of included studies was moderate to high, and publication bias was undetectable. In conclusion, in this largest meta-analysis of hypertensive patients, the nocturnal BP fall provided substantial prognostic information, independent of 24-hour SBP levels.</description><subject>Adult</subject><subject>Aged</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Blood Pressure Monitoring, Ambulatory - methods</subject><subject>Blood Pressure Monitoring, Ambulatory - standards</subject><subject>Cardiovascular Diseases - prevention & control</subject><subject>Circadian Rhythm - physiology</subject><subject>Diastole - drug effects</subject><subject>Diastole - physiology</subject><subject>Female</subject><subject>Humans</subject><subject>Hypertension - drug therapy</subject><subject>Hypertension - physiopathology</subject><subject>Hypotension - physiopathology</subject><subject>Internationality</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Proportional Hazards Models</subject><subject>Risk Assessment</subject><subject>Systole - drug effects</subject><subject>Systole - physiology</subject><issn>0194-911X</issn><issn>1524-4563</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkVFv0zAUhS0EYt3GX0DmbXvIsB3bcZB4yKqOTBpdBUXAU-QkNzTgxp3tMPVf8RNx6YbQHtD8Yvn4fOde6SD0ipIzSiV9XX5dzD4sZ_OPl9fzoiyiKM6IzBV9giZUMJ5wIdOnaEJozpOc0i8H6ND774RQznn2HB0wmRPGczFBvxbOfhusD32DZ10HTcC2w2EFeG6bMLpBG3xurG3xwoH3owN8oY3B_YDL7QZcgMH3PwEvdOhhCP4NXka2WNej0cG67UN4ao3RtXXRboddyj2IP_dh9U9m_D0pzqdJeYrfQ9BJETfZ-t4fo2edNh5e3N1H6NPFbDktk6vrd5fT4ippuJI0YXWbc8GZUKJRIoWWdkIIQhpZZ0LXUrWsJiSXPBpUC5C2LTCakVqxlhAJ6RE62edunL0ZwYdq3fsG4vYD2NFXNMuYSlVKebTme2vjrPcOumrj-rV224qSaldY9aCwKIrqT2GRfXk3ZqzX0P4l7xuKhrd7w601AZz_YcZbcNUKtAmrRw3g_-FJPJxJlTBCJeHxleykLP0Nq_e40Q</recordid><startdate>201604</startdate><enddate>201604</enddate><creator>Salles, Gil F</creator><creator>Reboldi, Gianpaolo</creator><creator>Fagard, Robert H</creator><creator>Cardoso, Claudia R.L</creator><creator>Pierdomenico, Sante D</creator><creator>Verdecchia, Paolo</creator><creator>Eguchi, Kazuo</creator><creator>Kario, Kazuomi</creator><creator>Hoshide, Satoshi</creator><creator>Polonia, Jorge</creator><creator>de la Sierra, Alejandro</creator><creator>Hermida, Ramon C</creator><creator>Dolan, Eamon</creator><creator>O’Brien, Eoin</creator><creator>Roush, George C</creator><general>American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201604</creationdate><title>Prognostic Effect of the Nocturnal Blood Pressure Fall in Hypertensive Patients: The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) Meta-Analysis</title><author>Salles, Gil F ; 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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<0.001)untreated patients had increased risk of total CVEs (HR, 1.92), whereas treated patients had borderline lower risk (HR, 0.72) than normal dippers. For CVEs, heterogeneity was low for systolic night-to-day ratio and reverse/reduced dipping and moderate for extreme dippers. Quality of included studies was moderate to high, and publication bias was undetectable. In conclusion, in this largest meta-analysis of hypertensive patients, the nocturnal BP fall provided substantial prognostic information, independent of 24-hour SBP levels.</abstract><cop>United States</cop><pub>American Heart Association, Inc</pub><pmid>26902495</pmid><doi>10.1161/HYPERTENSIONAHA.115.06981</doi><tpages>8</tpages></addata></record> |
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| ispartof | Hypertension (Dallas, Tex. 1979), 2016-04, Vol.67 (4), p.693-700 |
| issn | 0194-911X 1524-4563 |
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| source | MEDLINE; American Heart Association Journals; EZB-FREE-00999 freely available EZB journals; Journals@Ovid Complete |
| subjects | Adult Aged Antihypertensive Agents - therapeutic use Blood Pressure Monitoring, Ambulatory - methods Blood Pressure Monitoring, Ambulatory - standards Cardiovascular Diseases - prevention & control Circadian Rhythm - physiology Diastole - drug effects Diastole - physiology Female Humans Hypertension - drug therapy Hypertension - physiopathology Hypotension - physiopathology Internationality Male Middle Aged Predictive Value of Tests Prognosis Proportional Hazards Models Risk Assessment Systole - drug effects Systole - physiology |
| title | Prognostic Effect of the Nocturnal Blood Pressure Fall in Hypertensive Patients: The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) Meta-Analysis |
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