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Increased total mortality is related to 24-hour pulse pressure dipping in patients with coronary artery disease
1Department of Pharmacology, Medical University of Gdansk - Gdansk (Poland) - Poland
2Medical University of Gdansk - Gdansk - Poland
3Department of Cardiology, Medical University of Gdansk - Gdansk (Poland) - Poland
Purpose. Elevated values of systolic (SBP), diastolic (DBP) blood pressure and pulse pressure (PP) are known to be powerful risk factors in cardiovascular (CV) diseases. The purpose of this study was to determine the association between PP and major adverse CV events (MACE), and all cause and CV mortality in different age groups of patients with coronary artery disease (CAD) confirmed by angiography.
Methods. To the PROGNOSIS (Prognostic Value of Ambulatory Blood Pressure Monitoring in Patients with Coronary Artery Disease Confirmed by Angiography) study there were included 1345 subjects. From total group of 1345 subjects, 891 with significant coronary artery stenosis =70% finally were included to the study. During baseline visit the following data were obtained: 1. two sphygmomanometric BP values; 2. 24-hour ABPM at 20-minute intervals (06:00 AM – 06:00 PM) and at 30-minute intervals (06:00 PM – 06:00 AM). Pulse pressure (PP) was calculated as SBP minus DBP. The percentage decrease in mean PP during the nighttime period was calculated as 100x[daytime PP mean – nighttime PP mean]/daytime PP mean. Using this percentage ratio, subjects were classified as dippers or non-dippers (nighttime relative PP decline =or <10%, respectively). From the time of the baseline visit to 31 December 2013 (median follow-up 8.3 years), the survival state was ascertained. The primary endpoint was cardiovascular mortality and secondary all-cause mortality. Major adverse coronary events (MACE) included CV mortality, total mortality and CV events. 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 or non smoking status and LDL cholesterol.
Results. The study group was divided to age subgroups: <65 y. (n=461, 352 male), 65-74 y. (n=330, 191 male), =75 y. (n=100, 67 male). There were 245 all-cause deaths including 114 CV deaths during the follow-up period. MACE occurred in 442 subjects, but revascularisations (PCI or CABG) were performed in 578 subjects. A Cox proportional regression analysis confirmed the relationship between PP dipping and risk of MACE HR (95%CI, 0.98 (0.96-0.99)), revascularization HR (95%CI, 0.98 (0.97-0.99)) only in group of the oldest subjects.
Conclusions. In contrast to younger CAD patients, PP dipping is related to MACE, and revascularization in very elderly CAD subjects.
ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.
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