title: Abnormal Circadian Blood Pressure Profile as a Prognostic Marker in Patients with Nonischemic Dilated Cardiomyopathy.
abstract: OBJECTIVE
  An abnormal circadian blood pressure (BP) profile is considered a risk factor for cardiovascular disease. However, its significance in heart failure patients with nonischemic etiology is unknown. Herein, we investigated the prognostic value of a circadian BP profile in patients with nonischemic dilated cardiomyopathy (NIDCM).
  
  
  METHODS
  We enrolled 114 NIDCM patients (76 males, mean age 53.1 years). The percent nighttime BP fall (%NBPF) was defined using ambulatory BP monitoring as a percent decrease in mean systolic BP in nighttime from daytime. All patients were divided into three groups: dipper (%NBPF ≥10), non-dipper (0 ≤ %NBPF < 10), and riser (%NBPF <0).
  
  
  RESULTS
  Riser patients had the highest serum creatinine levels (dipper, 0.78 ± 0.20 mg/dl; non-dipper, 0.85 ± 0.21 mg/dl; riser, 0.99 ± 0.23 mg/dl; p = 0.006). In survival analysis, riser patients had the highest cumulative cardiac-related deaths (log-rank, p = 0.001), which was an independent predictor of cardiac-related deaths (hazard ratio, 12.6; 95% confidence interval, 1.76-253; p = 0.01). Multivariate analysis revealed that the norepinephrine level at 24-hour collected urine (24 h U-NE) and the serum creatinine level were independent determinants of %NBPF (adjusted R2 = 0.20; 24 h U-NE, p = 0.0001; serum creatinine, p = 0.04).
  
  
  CONCLUSIONS
  The riser profile was associated with poor prognosis of NIDCM, which may reflect impaired sympathetic nervous system activity. Evaluating the circadian BP profile may be useful for risk stratification in NIDCM patients.
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Akinori
authors.initials: A
authors.lastname: Sawamura
authors.forename: Takahiro
authors.initials: T
authors.lastname: Okumura
authors.forename: Kyosuke
authors.initials: K
authors.lastname: Takeshita
authors.forename: Naoki
authors.initials: N
authors.lastname: Watanabe
authors.forename: Naoaki
authors.initials: N
authors.lastname: Kano
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Mori
authors.forename: Kenji
authors.initials: K
authors.lastname: Fukaya
authors.forename: Ryota
authors.initials: R
authors.lastname: Morimoto
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hirashiki
authors.forename: Yasuko Kureishi
authors.initials: YK
authors.lastname: Bando
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: D054058:Acute Coronary Syndrome / Q000209:etiology; D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000401:mortality; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D020521:Stroke / Q000209:etiology
chemical_list: D002316:Cardiotonic Agents