Nighttime BP dipping abnormalities in young adults linked to later atherosclerosis

Oct 15 2012

By Piriya Mahendra, medwireNews Reporter

Young adults whose systolic blood pressure (BP) fails to dip sufficiently or overdips during nighttime may be at increased risk for coronary atherosclerosis later in life, research reveals.

Data from the ambulatory BP monitoring substudy of the Coronary Artery Risk Development in Young Adults Study showed that individuals with the least pronounced or absent systolic BP dipping ratio (fourth quartile) were four times more likely than those with a dipping ratio in the next highest range (third quartile) to have coronary artery calcium (CAC), an indicator of atherosclerosis, 10-15 years later.

The mean age of the 239 participants was 30 years at baseline, and the systolic BP dipping ratio in the fourth quartile ranged from 0.92 to 1.24, and in the third quartile from 0.88 to 0.92.

The 60 participants with the most pronounced dipping ratio (0.72-0.85; first quartile) also had a greater risk for CAC than those with a dipping ratio in the third quartile, at an odds ratio of 4.76.

Anthony Viera (University of North Carolina at Chapel Hill, USA) and team found that the U-shaped relationship between systolic BP dipping ratio and future CAC persisted after adjustment for multiple potential confounders.

"Our analysis suggests that coronary artery calcium may be a potential mediator of the relationship between abnormal nighttime BP pattern and cardiovascular disease," they write in Hypertension.

Viera and team add that nondipping and overdipping are potential risk factors for subclinical atherosclerosis beginning in young adulthood, even in the absence of hypertension.

"The finding may be of prognostic importance, implying that, when abnormal BP patterns are detected, they can be a harbinger of greater cardiovascular disease risk in years to come," they suggest. "Those at increased risk may warrant more aggressive control of risk factors and closer monitoring for development of hypertension."

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