Is nighttime blood pressure important in cardiovascular risk assessment in coronary atherosclerosis?

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.