Effects of abnormal circadian rhythm of blood pressure on prognosis of patients with dilated cardiomyopathy
YUAN Lin
TIAN Yi-lun
NIE Shao-ping
Abstract：Objectives 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 106 NIDCM patients (74 males, mean age 52.7 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), nondipper (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 (24h U-NE) and the serum creatinine level were independent determinants of %NBPF (adjustedR2=0.20; 24h 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.
Keywords：Dilated cardiomyopathyAmbulatory blood pressure monitoringCircadian rhythm
Publication Date：2017-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 545-549 )