Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Research Letter
  • Published:

Is nighttime blood pressure important in cardiovascular risk assessment in coronary atherosclerosis?

Journal of Human Hypertension volume 28, pages 564–566 (2014)Cite this article

Subjects

Elevated nighttime blood pressure (BP) values have a pivotal role in cardiovascular risk assessment in the general population. However, the role of elevated nighttime BP in hypertensive patients with established coronary atherosclerosis is unknown. In the PROGNOSIS (Prognostic Value of Ambulatory Blood Pressure Monitoring in Patients with Coronary Artery Disease Confirmed by Angiography) study, we evaluated the relationship between abnormal nighttime BP and major adverse cardiac events (MACE) over a median 6.6-year observation period of hypertensive subjects with coronary atherosclerosis established by coronary angiography. There was a higher prevalence of abnormal nighttime BP (defined as mean nighttime BP values ⩾120/70 mm Hg) in patients with MACE than those without MACE (58% vs 48%, P <0.01). The curves of cumulative incidence revealed a higher risk of MACE in subjects with abnormal nighttime BP than in those without nighttime hypertension during the follow-up period. Our findings might indicate that nighttime BP contribute to increased cardiovascular risk in subjects with coronary atherosclerosis established by coronary angiography.

Epidemiological studies have reported that elevated BP predicts mortality and morbidity independently of other cardiovascular (CV) risk factors.1 Findings from studies of general populations have confirmed that nighttime BP is a stronger predictor for CV events than office or daytime BP.2, 3 A 24-h BP monitoring (ABPM) providing BP recordings during both daytime and nighttime periods supplies more comprehensive information concerning diurnal BP profile. The main constraint is that present ABPM data are limited, particularly for general populations, populations with both untreated and treated hypertension, and high CV risk populations. So far, only a few small prospective studies have been conducted on patients with coronary heart disease (diagnosis only confirmed by medical history or by noninvasive procedures). As first Fagard et al.4 performed a meta-analysis of three studies dealing with 24-h ABPM. Among 302 patients with CV diseases in their history (including coronary artery disease), it was revealed that nighttime BP was a better predictor of death and recurrent CV events over a mean 6.8-year observation period. However, the limitation of this study was that coronary revascularizations in the follow-up period were not taken into account. So far only one small study, in addition non-prospective, was performed on 136 male patients with coronary atherosclerosis confirmed by coronary angiography. In their study, Mousa et al.5 reported that men with significant coronary atherosclerosis had higher nighttime BPs than men without coronary atherosclerosis. The clinical implication of this finding has remained unknown. Elevated nighttime BP is an established CV risk factor in hypertensives, so we expect that nighttime hypertension might be one of the particular determinants of higher CV risk in the group of hypertensive patients with confirmed coronary artery disease. Therefore, the main purpose of the present study was to evaluate significance of elevated nighttime BP values in CV risk assessment in the cohort of patients with coronary atherosclerosis confirmed by coronary angiography.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

References

  1. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M et al. ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013; 31: 1281–1357.

    Article  CAS  Google Scholar 

  2. Fagard RH, Celis H, Thijs L, Staessen JA, Clement DL, De Buyzere ML et al. Daytime and nighttime blood pressure as predictors of death and cause-specific cardiovascular events in hypertension. Hypertension 2008; 51: 55–61.

    Article  CAS  Google Scholar 

  3. Hansen TW, Li Y, Boggia J, Thijs L, Richart T, Staessen JA . Predictive role of the nighttime blood pressure. Hypertension 2011; 57: 3–10.

    Article  CAS  Google Scholar 

  4. Fagard RH, Thijs L, Staessen JA, Clement DL, De Buyzere ML, De Bacquer DA . Prognostic significance of ambulatory blood pressure in hypertensive patients with history of cardiovascular disease. Blood Press Monit 2008; 13: 325–332.

    Article  Google Scholar 

  5. Mousa T, el-Sayed MA, Motawea AK, Salama MA, Elhendy A . Association of blunted nighttime blood pressure dipping with coronary artery stenosis in men. Am J Hypertens 2004; 17: 977–980.

    Article  Google Scholar 

  6. Van de Werf F, Ardissino D, Betriu A, Cokkinos DV, Falk E, Fox KA et al. Management of acute myocardial infarction in patients presenting with ST-segment elevation. The task force on the management of acute myocardial infarction of the European Society of Cardiology. Eur Heart J 2003; 24: 28–66.

    Article  Google Scholar 

  7. Bertrand ME, Simoons ML, Fox KA, Wallentin LC, Hamm CW, McFadden E et al. Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2002; 23: 1809–1840.

    Article  Google Scholar 

  8. Turner ST, Bielak LF, Narayana AK, Sheedy 2nd PF, Schwartz GL, Peyser PA . Ambulatory blood pressure and coronary artery calcification in middle-aged and younger adults. Am J Hypertens 2002; 15: 518–524.

    Article  Google Scholar 

  9. Sobiczewski W, Wirtwein M, Trybala E, Gruchala M . Severity of coronary atherosclerosis and stroke incidence in 7-year follow-up. J Neurol 2013; 260: 1855–1858.

    Article  Google Scholar 

  10. Hermida RC, Ayala DE, Mojon A, Fernandez JR . Sleep-time blood pressure and the prognostic value of isolated-office and masked hypertension. Am J Hypertens 2012; 25: 297–305.

    Article  Google Scholar 

  11. Hermida RC, Ayala DE, Fernandez JR, Mojon A . Sleep-time blood pressure: prognostic value and relevance as a therapeutic target for cardiovascular risk reduction. Chronobiol Int 2013; 30: 68–86.

    Article  Google Scholar 

  12. Turton MB, Deegan T . Circadian variations of plasma catecholamine, cortisol and immunoreactive insulin concentrations in supine subjects. Clin Chim Acta 1974; 55: 389–397.

    Article  CAS  Google Scholar 

  13. Brandenberger G, Follenius M, Goichot B, Saini J, Spiegel K, Ehrhart J et al. Twenty-four-hour profiles of plasma renin activity in relation to the sleep-wake cycle. J Hypertens 1994; 12: 277–283.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. I Department of Cardiology, Medical University of Gdansk, Gdansk, Poland

    W Sobiczewski & M Gruchala

  2. Department of Pharmacology, Medical University of Gdansk, Gdansk, Poland

    M Wirtwein

Authors
  1. W Sobiczewski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Wirtwein
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M Gruchala
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M Wirtwein.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sobiczewski, W., Wirtwein, M. & Gruchala, M. Is nighttime blood pressure important in cardiovascular risk assessment in coronary atherosclerosis?. J Hum Hypertens 28, 564–566 (2014). https://doi.org/10.1038/jhh.2013.141

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2013.141

This article is cited by

Search

Advanced search

Quick links