Details

Autor(en) / Beteiligte

• Palatini, Paolo
• Verdecchia, Paolo
• Beilin, Lawrence J
• Eguchi, Kazuo
• Imai, Yutaka
• Kario, Kazuomi
• Ohkubo, Takayoshi
• Pierdomenico, Sante D
• Saladini, Francesca
• Schwartz, Joseph E
• Wing, Lindon
• Signorotti, Sara
• Reboldi, Gianpaolo

Titel

Association of Extreme Nocturnal Dipping With Cardiovascular Events Strongly Depends on Age

Ist Teil von

• Hypertension (Dallas, Tex. 1979), 2020-02, Vol.75 (2), p.324-330

Ort / Verlag

United States: American Heart Association, Inc

Erscheinungsjahr

2020

Quelle

Free E-Journal (出版社公開部分のみ）

Beschreibungen/Notizen

• Whether extreme dipping is associated with cardiovascular events (CVE) is unclear. The present study was conducted to test the hypothesis that the prognostic role of extreme dipping varies as a function of age. The analysis was performed in 10 868 participants (53% men) aged 53±15 (mean±SD) years enrolled in 8 prospective studies. Using the ambulatory systolic blood pressure nocturnal decline, we identified 4 groupsdippers (>10%–20%), nondippers (>0%–10%), reverse dippers (≤0%), and extreme dippers (>20%). The association between dipping category and CVE was estimated as a function of age using Cox models adjusted for sex, average 24-hour systolic blood pressure, and traditional risk factors. During a median follow-up of 5.7 years, there were a total of 829 CVE (168 fatal). For extreme dippers, no increase in risk of CVE was observed among the participants <70 years (hazard ratio, 0.99 [95% CI, 0.73–1.34]; P=0.93) compared with dippers. In contrast, among the participants ≥70 years, there was a significant increase in risk (hazard ratio, 1.88 [95% CI, 1.14–3.11]; P=0.013). Among the octogenarians, the hazard ratio (95% CI) for CVE were 2.34 (1.12–4.93) for nondippers (P=0.024), 3.91 (1.75–8.73) for reverse dippers (P=0.001), and 4.12 (1.64–10.37) for extreme dippers (P=0.003) compared with dippers. These data show that extreme dipping is not associated with poorer outcome in people younger than 70 years. A U-shaped relationship between nocturnal blood pressure dipping and adverse outcome is present in subjects older than 70 years. In the octogenarian extreme dippers, the risk of CVEs was 4× higher than in the dippers and similar to that in the reverse dippers.