title: Association of diurnal blood pressure pattern with risk of hospitalization or death in men with heart failure.
abstract: BACKGROUND
  An altered diurnal blood pressure (BP) pattern has been linked to the risk of developing heart failure (HF). We tested whether an altered diurnal BP pattern is associated with adverse outcomes (death or hospitalization for HF exacerbation) in patients with HF.
  
  
  RESULTS
  A total of 118 patients with HF were enrolled from a tertiary care HF clinic and followed for death or HF hospitalization for up to 4 years; 24-hour ambulatory BP was monitored. Forty patients (34%) had a normal BP dipping pattern (night-day ambulatory BP ratio < 0.9), 44 patients (37%) had a nondipping pattern (0.9 < or = night-day ambulatory BP ratio < 1.0), and 34 patients (29%) had a reverse dipping BP pattern (night-day ambulatory BP ratio > or = 1.0). A total of 39 patients had an adverse outcome. Adverse outcome rates were the lowest in dippers and the highest in reverse dippers (log rank P = .052). Predictors of adverse outcomes, selected on the basis of log likelihood contrast, were as follows: New York Heart Association functional class (hazard ratio [HR] 1.96, 95% confidence interval [CI] 1.11-3.44), anemia (HR 2.50, 95% CI 1.23-5.08), and dipping status (HR 1.65, 95% CI 1.08-2.50).
  
  
  CONCLUSIONS
  In addition to other traditional predictors, BP dipping status may be an important prognostic factor in HF.
authors.affiliation: College of Pharmacy, University of Florida, Gainesville, Florida, USA.
authors.forename: Jaekyu
authors.initials: J
authors.lastname: Shin
authors.forename: Sharoen
authors.initials: S
authors.lastname: Kline
authors.forename: Mariellen
authors.initials: M
authors.lastname: Moore
authors.forename: Yan
authors.initials: Y
authors.lastname: Gong
authors.forename: Viralkumar
authors.initials: V
authors.lastname: Bhanderi
authors.forename: Carsten M
authors.initials: CM
authors.lastname: Schmalfuss
authors.forename: Julie A
authors.initials: JA
authors.lastname: Johnson
authors.forename: Richard S
authors.initials: RS
authors.lastname: Schofield
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D002940:Circadian Rhythm / Q000502:physiology*; D003643:Death; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors