Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
Time point of nocturnal trough systolic blood pressure as an independent predictor of cardiovascular events
First author：Jing Zhu, Xiwa Hao ,Hefei Tang
Corresponding author：Yong jun Wang
essential_information
- Person in charge：Jing Zhu, Xiwa Hao ,Hefei Tang
- Data Sources： BOSS
- Number of papers：BOSS20190918
- Published time：2022-02-03
2022-02-03
Published articles
Journal：Journal of Clinical Hypertension
Publication type: Original Contributions
IF(IF): 3.78
PMID: 35118806 Link To Pubmed Full text Download
Background And Purpose
Background：Circadian clock are known to regulate blood pressure. ABPM has been considered as the gold standard for measuring circadian changes in blood pressure. The average Nighttime BP has been suggested as a strong risk factor for cardiovascular events. However, few studies focused on the nocturnal trough blood pressure and its corresponding time point. As we known, the time point at which the lowest blood pressure emerging at night is different in each person. And a recent study found that nighttime SBP at 2:00 to 3:00 seems likely to be a reliable predictor for cardiovascular risk. But it is unclear whether the corresponding time point of nocturnal trough BP itself could predict cardiovascular risk. Aim：To assess the predictive ability of nocturnal trough SBP and its corresponding time for CVE and recurrence stroke in ischemic stroke and transient ischemic attack (TIA) patients.
Method
The effects of T-NTSBP and NTSBP on clinical events were evaluated by multivariable cox regression models in BOSS study population.The hazard ratio (HR) was tested after adjustment for the following variables: Age, Gender, Smoking, Drinking, medical history (Atrial fibrillation, Hypertension, Diabetes mellitus, Hyperlipidemia), secondary prevention (Antiplatelet, anti-hypertension, Lowering-lipid, Anti-diabetic), NTBSP, Average nighttime Systolic. We established two models about the effects of NTSBP on clinical events. In model I, the covariates were as follows: Age, Gender, Smoking, Drinking, medical history (Atrial fibrillation, Hypertension, Diabetes mellitus, Hyperlipidemia), secondary prevention drug (Antiplatelet, anti-hypertension, Lowering-lipid, Anti-diabetic). We further adjusted for average nighttime Systolic (model II). We used Kaplan-Meier survival function estimates to compare the incidence rates of CVE and recurrent stroke according to T-NTSBP in the study population.
Conclusion
Both of NTSBP and T-NTSBP were important predictors for short-term cardiovascular risk in ischemic stroke and TIA patients.
Main results
According to NTSBP classified by quartile, hazard ratio (HR) with 95% confidence interval (CI) for NTSBP quartile 4 (>129 mm Hg) was 2.727 (1.148–6.478) for CVE at 90-day, compared with quartile 1 (≤102 mm Hg). However, an attenuated association between NTSBP and CVE was observed at 1 year. In addition, we observed the group of T-NTSBP at 4:00–6:00 had a lowest CVE incidence at 90 days among four groups (22:00–23:59, 00:00–1:59 2:00–3:59, 4:00–6:00). After multivariable adjustment, T-NTSBP was significantly associated with CVE incidence at 90 days (T-NTSBP at the 4:00–6:00 versus the 22:00–23:59 group: HR, 0.433; 95%CI, 0.190–0.986),independent of NTSBP and average nocturnal SBP.