The 24-h blood pressure measurement may predict mortality and cardiovascular events in hypertensive patients with coronary artery disease.
The aim of this prospective study was to evaluate the relationship between 24-h blood pressure (BP) values and cardiovascular events in hypertensive patients with coronary artery disease in the long-term observation. Two hundred and seventy-four patients (mean age 56.9+/-9.3 years, 197 male, 77 female) who underwent coronary and renal angiography were investigated. Baseline characteristics included clinical and biochemical evaluations, 24-h BP measurement and standardized auscultatory readings - clinic BP. The composite end-point of death from all causes, nonfatal acute myocardial infarction, coronary revascularization and stroke were assessed at mean 40 months follow-up. Patients with the composite end-point had higher mean 24-h systolic BP (SBP) and diastolic BP (DBP) levels (124/74 vs. 117/71 mmHg; P<0.001 and P<0.05 for SBP and DBP, respectively), higher mean daytime SBP and DBP (127/76 vs. 119/72 mmHg; P<0.001 and P<0.05 for SBP and DBP, respectively) and higher night-time SBP and DBP (121/69 vs. 111/65 mmHg; P<0.001 and P<0.05 for SBP and DBP, respectively) at baseline. There were no differences in systolic and diastolic clinic BP levels between patients with and without the combined end-point. Multivariate Cox model revealed that only a number of coronary arteries stenosed and 24-h systolic BP level were independent predictors of occurrence of the composite end-point. In conclusion, our results indicate that 24-h BP measurement made in hospital but not the clinic standardized auscultatory readings predicts cardiovascular risk.
1st Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland.
Zofia
Z
Dzielińska
Aleksander
A
Prejbisz
Magdalena
M
Makowiecka-Cieśla
Andrzej
A
Januszewicz
Paweł
P
Tyczyński
Marcin
M
Demkow
Tomasz
T
Zieliński
Jacek
J
Kadziela
Elzbieta
E
Florczak
Witold
W
Ruzyłło
D000368:Aged; D018660:Blood Pressure Monitoring, Ambulatory; D016507:Cardiology Service, Hospital; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D003324:Coronary Artery Disease / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies