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

• Tipo: Artigo em Revista Científica Internacional
• Data: 2016

Autores

Salles, GF (Autor) Outra; Reboldi, G (Autor) Outra; Fagard, RH (Autor) Outra; Cardoso, CRL (Autor) Outra; Pierdomenico, SD (Autor) Outra; Verdecchia, P (Autor) Outra; Eguchi, K (Autor) Outra; Kario, K (Autor) Outra; Hoshide, S (Autor) Outra; Polonia, J (Autor) FMUP; de la Sierra, A (Autor) Outra; Hermida, RC (Autor) Outra; Dolan, E (Autor) Outra; O'Brien, E (Autor) Outra; Roush, GC (Autor) Outra

Revista

Título: Hypertension

Vol. 67

Páginas: 693-700

ISSN: 0194-911X

Editora: Wolters Kluwer Health

Indexação

ISI Web of Knowledge - 271 Citações

Scopus - 282 Citações

Outras Informações

ID Authenticus: P-00K-960

DOI: 10.1161/hypertensionaha.115.06981

Abstract (EN): 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 outcomes: from a 1-SD increase, summary HRs were 1.12 to 1.23. Reverse dipping also predicted all end points: HRs 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.

Idioma: Inglês

Tipo (Avaliação Docente): Científica

Nº de páginas: 8