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Decreasing Sleep-Time Blood Pressure Reduces Cardiovascular Risk

This study investigates the impact of decreasing sleep-time blood pressure on cardiovascular risk. Results show that a progressive decrease in sleep-time blood pressure is the most significant predictor of event-free survival. Proper patient evaluation by ambulatory monitoring is necessary to target this novel therapeutic strategy.

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Decreasing Sleep-Time Blood Pressure Reduces Cardiovascular Risk

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  1. DECREASING SLEEP-TIME BLOOD PRESSURE DETERMINED BY AMBULATORY MONITORING REDUCES CARDIOVASCULAR RISK Ramón C. Hermida, PhD; Diana E. Ayala, MD, MPH, PhD; Artemio Mojón, PhD; José R. Fernández, PhD Bioengineering & Chronobiology Laboratories, University of Vigo, Campus Universitario, Vigo, 36310 Spain www.clinicaltrials.gov, NCT00295542

  2. Objectives • We investigated whether reduced cardiovascular risk is more related to the progressive decrease of asleep or awake blood pressure. J Am Coll Cardiol 2011;58:1165-1173

  3. Background • Independent studies have concluded that elevated sleep-time blood pressure is a better predictor of cardiovascular risk than the awake or 24h blood pressure means. • However, the impact on cardiovascular risk of changes in these ambulatory blood pressure characteristics has not been properly investigated. J Am Coll Cardiol 2011;58:1165-1173

  4. Methods • We prospective studied 3344 subjects (1718 men/1626 women), 52.6±14.5 years of age, during a median follow-up of 5.6 years. • Those with hypertension at baseline were randomized to ingest all their prescribed hypertension medications upon awakening or ≥1 of them at bedtime. • Blood pressure was measured for 48h at baseline, and again annually or more frequently (quarterly) if treatment adjustment was required. J Am Coll Cardiol 2011;58:1165-1173

  5. Results • Using data collected at baseline, when asleep blood pressure was adjusted by awake mean, only the former was a significant predictor of outcome in a Cox proportional-hazard model also adjusted for sex, age, and diabetes. • Analyses of changes in ambulatory blood pressure during follow-up revealed a 17% reduction in cardiovascular risk for each 5 mmHg decrease in asleep systolic blood pressure mean (P<0.001), independently of changes in any other ambulatory blood pressure parameter. J Am Coll Cardiol 2011;58:1165-1173

  6. HR as a function of the change in asleep SBP mean during follow-up HR was adjusted by age, sex, diabetes, baseline BP, and number of hypertension medications used for treatment. Studied population was divided into five classes of equal size (quintiles). Negative change indicates a BP reduction during follow-up. J Am Coll Cardiol 2011;58:1165-1173

  7. HR as a function of the change in clinic SBP during follow-up. HR was adjusted by age, sex, diabetes, baseline BP, and number of hypertension medications used for treatment. Studied population was divided into five classes of equal size (quintiles). Negative change indicates a BP reduction during follow-up. J Am Coll Cardiol 2011;58:1165-1173

  8. Conclusions • The sleep-time blood pressure mean is the most significant prognostic marker of cardiovascular morbidity and mortality. • Most important, the progressive decrease in asleep blood pressure, a novel therapeutic target that requires proper patient evaluation by ambulatory monitoring, was the most significant predictor of event-free survival. J Am Coll Cardiol 2011;58:1165-1173

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