title: Prognostic Value of Nondipping and Morning Surge in Elderly Treated Hypertensive Patients With Controlled Ambulatory Blood Pressure.
abstract: BACKGROUND
  The independent prognostic significance of nondipping and morning surge (MS) of blood pressure (BP) in treated hypertensive patients with controlled ambulatory BP is not yet clear. We investigated the association between the aforesaid ambulatory BP parameters and cardiovascular risk in elderly treated hypertensive patients with normal achieved ambulatory BP.
  
  
  METHODS
  The occurrence of a composite end-point (stroke, coronary events, heart failure, and peripheral revascularization) was evaluated in 391 elderly treated hypertensive patients (age range 60-90 years) with controlled ambulatory BP (both daytime BP <135/85 mm Hg and nighttime BP <120/70 mm Hg). According to nighttime change and MS of systolic BP, subjects were divided in dippers with normal or high MS (>23 mm Hg) and nondippers.
  
  
  RESULTS
  During the follow-up (9.3 ± 4.6 years, range 0.5-20 years), 76 events occurred. The event-rate was 2.09 per 100 patient-years. After adjustment for age, gender, left ventricular (LV) hypertrophy, asymptomatic LV systolic dysfunction at baseline and left atrial enlargement, dippers with high MS (hazard ratio 2.45, 95% confidence interval 1.27-4.73, P = 0.007) and nondippers (hazard ratio 2.04, 95% confidence interval 1.18-3.53, P = 0.01) were at higher cardiovascular risk than dippers with normal MS.
  
  
  CONCLUSIONS
  In elderly treated hypertensive patients with normal achieved ambulatory BP, dippers with high MS and nondippers are at increased cardiovascular risk.
authors.affiliation: Dipartimento di Scienze Mediche, Orali e Biotecnologiche, Università "Gabriele d'Annunzio", Chieti-Pescara, Italy; pierdomenico@unich.it santedonato.pierdomenico@fastwebnet.it.|Centro di Ricerca Clinica, Fondazione Università "Gabriele d'Annunzio", Chieti-Pescara, Italy.
authors.forename: Sante D
authors.initials: SD
authors.lastname: Pierdomenico
authors.affiliation: Centro di Ricerca Clinica, Fondazione Università "Gabriele d'Annunzio", Chieti-Pescara, Italy.|Dipartimento di Medicina e Scienze dell'Invecchiamento, Università "Gabriele d'Annunzio", Chieti-Pescara, Italy.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Pierdomenico
authors.affiliation: Dipartimento di Medicina e Scienze dell'Invecchiamento, Università "Gabriele d'Annunzio", Chieti-Pescara, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Coccina
authors.affiliation: Centro di Ricerca Clinica, Fondazione Università "Gabriele d'Annunzio", Chieti-Pescara, Italy.|Dipartimento di Medicina e Scienze dell'Invecchiamento, Università "Gabriele d'Annunzio", Chieti-Pescara, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Lapenna
authors.affiliation: Dipartimento di Scienze Mediche, Orali e Biotecnologiche, Università "Gabriele d'Annunzio", Chieti-Pescara, Italy.|Centro di Ricerca Clinica, Fondazione Università "Gabriele d'Annunzio", Chieti-Pescara, Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: Porreca
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D015996:Survival Rate / Q000639:trends
chemical_list: D000959:Antihypertensive Agents
keywords: ambulatory blood pressure; blood pressure; cardiovascular risk; dippers; hypertension; morning surge; nondippers.