Prognostic significance of nocturnal fall of systolic arterial pressure in patients with mild and moderate essential hypertension (7-9-year prospective trial)

Abstract

Aim. To study a relationship between a carcadian blood pressure (BP) rhythm and cardiovascular events (CE) during 7-9 year follow-up in males with mild to moderate essential hypertension (EH). Material and methods. 50 males (mean age 48.6 + 0.7 years) with mild to moderate EH were prospectively followed up for 7-9 years (8.4 ±0.1 years). We analysed 24-h BP recordings and protocol of echocardiography performed during the first hospitalization. The patients were divided into three groups: group 1 (n = 18) with normal (10-20%) nocturnal fall of systolic BP (NF SBP) and normal left ventricular mass index (LVMI 125 g/m2. In these groups we assessed the prevalence ofCE: myocardial infarction (MI), stroke (S), sudden death (SD), new cases of angina pectoris (AP), transient cerebral ischemic attack (T1A). Results. No significant differences were found between the groups by mean age, body mass index, duration of arterial hypertension, mean 24-h and awake systolic and diastolic BP while significant differences were by nighttime BP profile parameters. During the follow-up 16 CE in 12 patients were documented (3 fatal and 13 nonfatal). In group 1 CE were observed in 1 patient (twice MI), in group 2-7 cases of CE (1 S, 1 TCIA, 2 Ml, 2 AP) in 6 patients, in group 3-7 cases (2 MI, 3 TIA, 2 AP) in 5 patients, 3 of them were fatal. Conclusion. Insufficient nocturnal fall ofSBP (< 10%) is an adverse prognostic factor for cardiovascular morbidity in mild to moderate essential male hypertensives.

Keywords

• essential hypertension
• 24-h monitoring of arterial pressure
• circadkm rhythm
• cardiovascular events
• prospective follow-up