Blunted nocturnal BP decline predicts all-cause, cardiovascular mortality

Aberrations in the circadian pattern appear to elevate the risk of all-cause and cardiovascular mortality, even without elevations in nocturnal blood pressure (BP), reveals a study.

A team of investigators identified a total of 59,124 patients enrolled in the Spanish ABPM Registry between 2004 and 2014 (median follow-up 10 years). They used the death certificates of these patients to obtain data on vital status and cause of death.

Cox proportional models adjusted for clinical confounders and 24-h BP were used to assess the association of night-to-day ratio (NDR) and dipping patterns (extreme dippers, dippers, reduced dippers, and risers) with all-cause and cardiovascular mortality.

NDR significantly correlated with a higher risk of all-cause mortality (hazard ratio [HR], 1.15, 95 percent confidence interval [CI], 1.13‒1.17), as did reduced dippers (HR, 1.13, 95 percent CI, 1.06‒1.20) and risers (HR, 1.41, 95 percent CI, 1.32‒1.51), but not extreme dippers (HR, 0.90, 95 percent CI, 0.79‒1.02).

Increased NDR In the absence of elevated night SBP (<120 mm Hg) was also significantly associated with a higher risk of death (HR, 1.13, 95 percent CI, 1.04‒1.22), as was elevated night SBP but normal NDR (HR, 1.38, 95 percent CI, 1.26‒1.50) and the combination of both abnormalities (HR, 1.56, 95 percent CI, 1.46‒1.66). Notably, results were similar for cardiovascular mortality.