RESUMEN
Elevated pulse pressure (PP) as a difference between systolic and diastolic blood pressure is a significant risk factor of cardiovascular (CV) diseases. The goal of our study was to determine the association between PP and major adverse CV events (MACEs), and all-cause and CV mortality in the different age groups of patients with coronary artery disease (CAD) confirmed by angiography. To the PROGNOSIS study, finally there were included 891 subjects with CAD. An analysis of the receiver operating characteristic was used for predicting PP dipping among the age groups of patients. A COX proportional hazards model was used to examine the association between PP and PP dipping and risk of MACE, revascularization, CV and total mortality after adjusting for sex, diabetes, smoking and low-density lipoprotein cholesterol. The median follow-up period was 8.3 years (interquartile range: 5.3-9.0 years). There were 245 (27%) all-cause deaths including 114 (13%) CV deaths during the follow-up period. MACE occurred in 442 (50%) subjects, but coronary artery interventions (percutaneous coronary intervention or coronary artery bypass grafting) were performed in 578 subjects (65%). A Cox proportional regression analysis confirmed the relationship between PP dipping as well as PP dipping thresholds points and risk of MACE and total mortality only in the group of the oldest subjects. In contrast to younger CAD patients, PP dipping is related to MACE, CV and total mortality in very elderly CAD subjects. Nocturnal PP values tend to be higher than diurnal PP values in the oldest CAD individuals. In conclusion, in contrast to younger CAD patients, PP dipping is related to MACE, CV and total mortality in very elderly CAD subjects. Nocturnal PP values tend to be higher than diurnal PP values in the oldest CAD individuals.
Asunto(s)
Monitoreo Ambulatorio de la Presión Arterial/métodos , Presión Sanguínea/fisiología , Ritmo Circadiano/fisiología , Hipertensión/mortalidad , Anciano , Causas de Muerte/tendencias , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Polonia/epidemiología , Pronóstico , Tasa de Supervivencia/tendencias , Factores de TiempoRESUMEN
Elevated nighttime blood pressure (BP) values have a pivotal role in cardiovascular risk assessment in the general population. However, the role of elevated nighttime BP in hypertensive patients with established coronary atherosclerosis is unknown. In the PROGNOSIS (Prognostic Value of Ambulatory Blood Pressure Monitoring in Patients with Coronary Artery Disease Confirmed by Angiography) study, we evaluated the relationship between abnormal nighttime BP and major adverse cardiac events (MACE) over a median 6.6-year observation period of hypertensive subjects with coronary atherosclerosis established by coronary angiography. There was a higher prevalence of abnormal nighttime BP (defined as mean nighttime BP values > or = 120/70 mmHg) in patients with MACE than those without MACE (58% vs. 48%, P < 0.01). The curves of cumulative incidence revealed a higher risk of MACE in subjects with abnormal nighttime BP than in those without nighttime hypertension during the follow-up period. Our findings might indicate that nighttime BP contribute to increased cardiovascular risk in subjects with coronary atherosclerosis established by coronary angiography.