Nighttime blood pressure dipping in postmenopausal women with coronary heart disease.
BACKGROUND
Blunted nighttime blood pressure (BP) dipping is prognostic of cardiovascular morbidity and mortality. This relationship may be stronger among women than men. The present study hypothesized that coronary artery disease (CAD) and advancing age would be associated with reduced BP dipping in postmenopausal women. The effects of daytime physical activity and nighttime sleep quality on BP dipping were also examined.


METHODS
54 postmenopausal women with CAD (≥50% occlusion of at least one major coronary vessel) and 48 age-matched (range 50-80 years) postmenopausal women without CAD (non-CAD) underwent 24-h ambulatory BP monitoring and actigraphic evaluations of daytime physical activity and nighttime sleep efficiency.


RESULTS
Women with CAD evidenced higher nighttime systolic BP (SBP) (P = 0.05) and blunted SBP dipping (P = 0.017), blunted diastolic BP (DBP) dipping (P = 0.047), and blunted pulse pressure dipping (P = 0.01), compared to non-CAD women. Multivariable regression models showed that the presence of CAD, age, daytime physical activity, and nighttime sleep efficiency were independently related to the magnitude of SBP dipping, together accounting for 25% of its variability. DBP dipping showed similar associations.


CONCLUSIONS
For postmenopausal women, the presence of CAD and advancing age are accompanied by blunted nighttime BP dipping, which may increase the risk of adverse cardiovascular events. Lifestyle changes that increase daytime physical activity and improve nighttime sleep quality may help improve cardiovascular risk by enhancing nighttime BP dipping.
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA. sherw002@mc.duke.edu
Andrew
A
Sherwood
Julie K
JK
Bower
Faye S
FS
Routledge
James A
JA
Blumenthal
Judith A
JA
McFetridge-Durdle
L Kristin
LK
Newby
Alan L
AL
Hinderliter
D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000209:etiology; D002940:Circadian Rhythm / Q000502:physiology*; D003324:Coronary Artery Disease / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D017698:Postmenopause / Q000502:physiology*; D012890:Sleep