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Impaired diurnal blood pressure variation and all-cause mortality.
Am J Hypertens. 2008 Jan; 21(1):92-7.AJ

Abstract

BACKGROUND

Most healthy people exhibit a decrease in systolic blood pressure (SBP) at night. A drop of <10% from mean daytime values, "non-dipping," is associated with kidney disease and cardiovascular events. We hypothesized that non-dipping would predict all-cause mortality.

METHODS

Consecutive patients referred for ambulatory blood pressure (BP) monitoring at the Cleveland Clinic between 1994 and 2004 were included. Mean daytime (6 AM-11 PM) and nighttime (11 PM-6 AM) SBP values were calculated. We examined diurnal BP variation as a continuous variable, ((Mean daytime SBP - Mean nighttime SBP)/(Mean daytime SBP)) x 100%, and also as a categorical variable, defining "non-dipping" as a nocturnal SBP drop of <10%; subjects who exhibited non-dipping were defined as "non-dippers" and the others as "dippers." All-cause mortality was ascertained from the Social Security Death Index.

RESULTS

Of the 621 patients included in the study, 261 were dippers and 360 were non-dippers. Non-dippers were older (P < 0.0001), more likely to be non-white (P < 0.05), and had higher rates of smoking, diabetes, hypertension, coronary artery disease, congestive heart failure, and renal insufficiency (P < 0.01 for all). Over a mean follow-up of 6.3 years, 61 patients died, including 10 dippers (3.8%) and 51 non-dippers (14.2%). The unadjusted hazard ratio for death based upon a decrement in the dipping percentage from the 75th to 25th percentile was 2.22 (95% confidence interval 1.64-2.95; P < 0.0001). This was attenuated after adjustment for comorbid conditions, including mean 24-h SBP and renal function: adjusted hazard ratio 1.62 (1.14-2.24; P < 0.005).

CONCLUSIONS

Blunted diurnal BP variation is a strong predictor of death, but this may be accounted for, in large part, by its association with other cardiovascular risk factors.

Authors+Show Affiliations

Brotman DJ
Hospitalist Program, Division of General Internal Medicine, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA. brotman@jhmi.edu
Davidson MB
No affiliation info available
Boumitri M
No affiliation info available
Vidt DG
No affiliation info available

MeSH

AgedBlood PressureBlood Pressure Monitoring, AmbulatoryCardiovascular DiseasesCircadian RhythmDiabetes MellitusFemaleFollow-Up StudiesHumansKaplan-Meier EstimateKidney DiseasesMaleMiddle AgedMortalityProportional Hazards ModelsRetrospective StudiesRisk AssessmentRisk FactorsTime Factors

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18091750

Clinical Trial Links

Meal Timing and Blood Pressure

Citation

Brotman, Daniel J., et al. "Impaired Diurnal Blood Pressure Variation and All-cause Mortality." American Journal of Hypertension, vol. 21, no. 1, 2008, pp. 92-7.
Brotman DJ, Davidson MB, Boumitri M, et al. Impaired diurnal blood pressure variation and all-cause mortality. Am J Hypertens. 2008;21(1):92-7.
Brotman, D. J., Davidson, M. B., Boumitri, M., & Vidt, D. G. (2008). Impaired diurnal blood pressure variation and all-cause mortality. American Journal of Hypertension, 21(1), 92-7.
Brotman DJ, et al. Impaired Diurnal Blood Pressure Variation and All-cause Mortality. Am J Hypertens. 2008;21(1):92-7. PubMed PMID: 18091750.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impaired diurnal blood pressure variation and all-cause mortality. AU - Brotman,Daniel J, AU - Davidson,Michael B, AU - Boumitri,Mirna, AU - Vidt,Donald G, PY - 2007/12/20/pubmed PY - 2008/3/14/medline PY - 2007/12/20/entrez SP - 92 EP - 7 JF - American journal of hypertension JO - Am J Hypertens VL - 21 IS - 1 N2 - BACKGROUND: Most healthy people exhibit a decrease in systolic blood pressure (SBP) at night. A drop of <10% from mean daytime values, "non-dipping," is associated with kidney disease and cardiovascular events. We hypothesized that non-dipping would predict all-cause mortality. METHODS: Consecutive patients referred for ambulatory blood pressure (BP) monitoring at the Cleveland Clinic between 1994 and 2004 were included. Mean daytime (6 AM-11 PM) and nighttime (11 PM-6 AM) SBP values were calculated. We examined diurnal BP variation as a continuous variable, ((Mean daytime SBP - Mean nighttime SBP)/(Mean daytime SBP)) x 100%, and also as a categorical variable, defining "non-dipping" as a nocturnal SBP drop of <10%; subjects who exhibited non-dipping were defined as "non-dippers" and the others as "dippers." All-cause mortality was ascertained from the Social Security Death Index. RESULTS: Of the 621 patients included in the study, 261 were dippers and 360 were non-dippers. Non-dippers were older (P < 0.0001), more likely to be non-white (P < 0.05), and had higher rates of smoking, diabetes, hypertension, coronary artery disease, congestive heart failure, and renal insufficiency (P < 0.01 for all). Over a mean follow-up of 6.3 years, 61 patients died, including 10 dippers (3.8%) and 51 non-dippers (14.2%). The unadjusted hazard ratio for death based upon a decrement in the dipping percentage from the 75th to 25th percentile was 2.22 (95% confidence interval 1.64-2.95; P < 0.0001). This was attenuated after adjustment for comorbid conditions, including mean 24-h SBP and renal function: adjusted hazard ratio 1.62 (1.14-2.24; P < 0.005). CONCLUSIONS: Blunted diurnal BP variation is a strong predictor of death, but this may be accounted for, in large part, by its association with other cardiovascular risk factors. SN - 0895-7061 UR - https://www.unboundmedicine.com/medline/citation/18091750/Impaired_diurnal_blood_pressure_variation_and_all_cause_mortality_ DB - PRIME DP - Unbound Medicine ER -