Diurnal Blood Pressure Pattern and Risk of Congestive Heart Failure
- Virk, Imran S. MD
- Tepper, David MD
Context
High blood pressure (BP) is the most important risk factor for congestive heart failure (CHF) at a population level, but the relationship of an altered diurnal BP pattern to the risk of subsequent CHF is unknown.
Objectives
To explore 24-hour ambulatory BP characteristics as predictors of CHF incidence and to investigate whether altered diurnal BP patterns confer any additional risk information beyond that provided by conventional office BP measurements.
Design, Setting, and Participants
Prospective, community-based, observational cohort in Uppsala, Sweden, including 951 elderly men free of CHF, valvular disease, and left ventricular hypertrophy at baseline between 1990 and 1995, followed until the end of 2002. Twenty-four-hour ambulatory BP monitoring was performed at baseline, and the BP variables were analyzed as predictors of subsequent CHF. The main outcome measure was first hospitalization for CHF.
Results
Seventy men developed CHF during follow-up, with an incidence rate of 8.6 per 1000 person-years at risk. In multivariable Cox proportional hazards models adjusted for antihypertensive treatment and established risk factors for CHF (myocardial infarction, diabetes, smoking, body mass index, and serum cholesterol level), a 1-SD (9-mm Hg) increase in nighttime ambulatory diastolic BP (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.02–1.55) and the presence of “nondipping” BP (night-day ambulatory BP ratio ≥1; HR, 2.29; 95% CI, 1.16–4.52) were associated with an increased risk of CHF. After adjusting for office-measured systolic and diastolic Bps, nondipping BP remained a significant predictor of CHF (HR, 2.21; 95% CI, 1.12–4.36 vs normal night-day pattern). Nighttime ambulatory diastolic BP and nondipping BP were also significant predictors of CHF after exclusion of all participants who had an acute myocardial infarction before baseline or during follow-up.
Conclusions
Nighttime BP appears to convey additional risk information about CHF beyond office-measured BP and other established risk factors for CHF. The clinical value of this association remains to be established in future studies.—Ingelsson E, Bjorklund-Bodegard K, Lind L, et al. Diurnal blood pressure pattern and risk of congestive heart failure. JAMA. 2006;295:2859–2866.