Dipping pattern and short-term blood pressure variability are stronger predictors of cardiovascular events than average 24-h blood pressure in young hypertensive subjects.
Level 3 - non-randomized controlled study
Prospective observational cohort study with 11.3-year follow-up
PubMed 35104844 · doi:10.1093/eurjpc/zwac020
What was done
Researchers evaluated 1,794 initially untreated hypertensive individuals aged ≤45 years pooled from two prospective observational studies (the HARVEST and PIUMA studies). Participants were evaluated for day-night blood pressure (BP) dipping patterns, short-term BP variability, and average 24-hour BP. The primary outcome was a composite of cardiovascular events (non-fatal myocardial infarction, stroke, heart failure hospitalization, cardiovascular death, or myocardial/limb revascularization) tracked over an 11.3-year follow-up using multivariable Cox proportional hazards models.
What was found
Over 11.3 years, 140 cardiovascular events occurred. A multivariable Cox model including BP variability and non-dipping was more informative (Akaike Information Criterion = 1536.9) than one using average 24-hour BP (Akaike Information Criterion = 1553.6). Stronger hazard ratios were observed for non-dipping (HR 2.22; 95% CI: 1.55–3.17; P < 0.0001) and high BP variability (HR 1.84; 95% CI: 1.26–2.65; P = 0.0015) than for high average 24-hour BP (HR 1.58; 95% CI: 1.07–2.33; P = 0.020). Adding average 24-hour BP to a nested model decreased the -2log likelihood from 1524.9 to 1519.3, with a non-significant interactive trend between 24-hour BP and non-dipping (P = 0.092).
Why it matters
Circadian BP patterns and short-term variability offer superior prognostic risk stratification compared to mean 24-hour ambulatory BP in young hypertensive patients. This indicates that ambulatory monitoring evaluation in young adults should prioritize fluctuation and dipping profiles over average pressure alone.
Limits
The study is observational and prone to residual confounding. The abstract does not define the specific thresholds or metrics used to classify 'high' BP variability or 'high' average 24-hour BP, nor does it describe subsequent treatment regimens initiated during the 11.3-year follow-up. Findings are limited to hypertensive adults aged ≤45 years and may not apply to older demographics.
Cited by
- supports People whose blood pressure does not dip during sleep ('non-dippers') have significantly higher cardiovascular, heart attack, and stroke risk.