Blunted Nocturnal FallinBloodPressure in Hypertensive Women WithFuture Cardiovascular MorbidEvents

Background. Inessential hypertension, a blunted orabsent nocturnal fall inblood pressure(BP)may beassociated withincreased target organdamage. Inthis case-control study, wetested thehypothesis that an association exists between ablunted orabsent nocturnal fall inBPandfuture cardiovascular morbid events inpatients withessential hypertension. Methods andResults. Casesubjects were32hypertensive patients witha first fatal ornonfatal major cardiovascular event whohadoff-therapy ambulatory BPmonitoring 1to5yearsearlier inthecontext of a registry ofmorbidity andmortality inhypertensive patients. Control subjects were49hypertensive patients freefromcardiovascular events. Thegroupswere matched withregard todateofbaseline ambulatory BPmonitoring, age,sex,clinic systolic anddiastolic BP,anddaytime ambulatory systolic and diastolic BP.Attheir baseline evaluation, casesandcontrols didnotdiffer, ineither sex,withrespect to clinic BP(men, 164/100 vs162/99 mm Hg;women, 178/96 vs180/93 mm Hg), mean daytime ambulatory BP(men, 151/94 vs147/95 mm Hg;women, 156/90 vs158/89 mm Hg), age(men, 55vs56years;women, 69vs68years), sex,bodyweight, serumcholesterol, knownduration andfamily history ofhypertension, smoking habits, renal function, or prevalence ofdiabetes. Echocardiographic left ventricular mass, determined inasubset ofpatients, wasgreater incasesthanincontrols inmen (145 vs115g/m2, P=.038) andwomen (137 vs102g/m2, P=.032). Thetimeinterval between baseline ambulatory BPmonitoring and subsequent cardiovascular event(cases: mean,2.1years) orlast contact with ourcenter (controls: mean, 2.5years) didnotdiffer between thegroups.Inthebaseline ambulatory BP profile, thenocturnal reductions ofsystolic anddiastolic BPinmen were9%and11%,respectively, incasesvs9%oand12%in controls (all P=NS),whereas inwomen they were3% and8% incasesvs 11%and16%incontrols (P=.002/.004). Conclusions. Thisretrospective case-control study suggests an association between thereduction or absence oftheusual nocturnal fall inBPandfuture cardiovascular morbid events inwhite women with essential hypertension. (Circulation. 1993;88:986-992.)