Pub Date : 2025-12-15eCollection Date: 2025-01-01DOI: 10.36660/abc.20250305
Mateus de Carvalho Gonçalves, Daniely Santos da Silva, Vitória Nogueira Ribeiro, Vanessa Burgugi Banin, Vanessa Dos Santos Silva, Rodrigo Bazan, Silméia Garcia Zanati Bazan, Pasqual Barretti, Luis Cuadrado Martin
Background: Sleep blood pressure (BP) fall is a prognostic marker. Few studies have evaluated whether systolic BP (SBP) or diastolic BP (DBP) dipping more accurately predicts clinical outcomes.
Objective: To determine which type of BP dipping has greater predictive value for clinical outcomes.
Methods: This retrospective cohort evaluated patients who underwent ambulatory blood pressure monitoring (ABPM) between January 27, 2004, and February 16,2012. Patients were followed until the occurrence of the primary outcome (death from any cause), or until the end of follow-up period (February 01, 2022). Cox survival curves were constructed to assess which dipping classification - SBP or DBP - better distinguished the occurrence of outcomes. Dipping was defined as a nocturnal BP reduction of 10-20%. Absent and attenuated dipping were defined as reductions of ≤ 0% and 0-10%, respectively. Statistical significance was set at p < 0.05.
Results: A total of 756 patients were included, with a mean age of 54±16.4 years; 42% were male. In predicting the primary outcome (all-cause mortality), the absence of DBP dipping, adjusted for 24-hour SBP, was associated with a hazard-ratio (HR) of 2.051 (95% confidence interval [95%CI]: 1.147 - 3.670 (p=0.015). For the secondary outcome (cardiovascular mortality), the absence of DBP dipping, also adjusted for 24-hour SBP, showed a HR of 3.329 (95%CI: 1.317-8.412; p=0.011). In contrast, the absence of SBP dipping, when adjusted for 24-hour SBP, was not significantly associated with either outcome. In the fully adjusted model, which included age, diabetes, smoking, atherosclerotic vascular disease and chronic kidney disease, both SBP and DBP dipping lost statistically significant associations.
Conclusion: DBP dipping demonstrates superior predictive power for outcomes compared to SBP dipping, and adds to the prognostic value of mean 24-hour SBP. (Central Illustration).
{"title":"Diastolic Blood Pressure Dipping During Sleep Shows Superior Unadjusted Predictive Power Compared to Systolic Dipping: A Retrospective Cohort Study.","authors":"Mateus de Carvalho Gonçalves, Daniely Santos da Silva, Vitória Nogueira Ribeiro, Vanessa Burgugi Banin, Vanessa Dos Santos Silva, Rodrigo Bazan, Silméia Garcia Zanati Bazan, Pasqual Barretti, Luis Cuadrado Martin","doi":"10.36660/abc.20250305","DOIUrl":"10.36660/abc.20250305","url":null,"abstract":"<p><strong>Background: </strong>Sleep blood pressure (BP) fall is a prognostic marker. Few studies have evaluated whether systolic BP (SBP) or diastolic BP (DBP) dipping more accurately predicts clinical outcomes.</p><p><strong>Objective: </strong>To determine which type of BP dipping has greater predictive value for clinical outcomes.</p><p><strong>Methods: </strong>This retrospective cohort evaluated patients who underwent ambulatory blood pressure monitoring (ABPM) between January 27, 2004, and February 16,2012. Patients were followed until the occurrence of the primary outcome (death from any cause), or until the end of follow-up period (February 01, 2022). Cox survival curves were constructed to assess which dipping classification - SBP or DBP - better distinguished the occurrence of outcomes. Dipping was defined as a nocturnal BP reduction of 10-20%. Absent and attenuated dipping were defined as reductions of ≤ 0% and 0-10%, respectively. Statistical significance was set at p < 0.05.</p><p><strong>Results: </strong>A total of 756 patients were included, with a mean age of 54±16.4 years; 42% were male. In predicting the primary outcome (all-cause mortality), the absence of DBP dipping, adjusted for 24-hour SBP, was associated with a hazard-ratio (HR) of 2.051 (95% confidence interval [95%CI]: 1.147 - 3.670 (p=0.015). For the secondary outcome (cardiovascular mortality), the absence of DBP dipping, also adjusted for 24-hour SBP, showed a HR of 3.329 (95%CI: 1.317-8.412; p=0.011). In contrast, the absence of SBP dipping, when adjusted for 24-hour SBP, was not significantly associated with either outcome. In the fully adjusted model, which included age, diabetes, smoking, atherosclerotic vascular disease and chronic kidney disease, both SBP and DBP dipping lost statistically significant associations.</p><p><strong>Conclusion: </strong>DBP dipping demonstrates superior predictive power for outcomes compared to SBP dipping, and adds to the prognostic value of mean 24-hour SBP. (Central Illustration).</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 10","pages":"e20250305"},"PeriodicalIF":1.9,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15eCollection Date: 2025-01-01DOI: 10.36660/abc.20250669
Renato Paladino Nemoto, Roney Orismar Sampaio
{"title":"Cost Implications and Perspectives of TAVI versus SAVR in the Hospital Setting.","authors":"Renato Paladino Nemoto, Roney Orismar Sampaio","doi":"10.36660/abc.20250669","DOIUrl":"10.36660/abc.20250669","url":null,"abstract":"","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 10","pages":"e20250669"},"PeriodicalIF":1.9,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15eCollection Date: 2025-01-01DOI: 10.36660/abc.20250327
Manuela Cristina Ribeiro Dias Barroso, Heleutério da Conceição Nicolau Madogolele, Deborah de Sá Pereira Belfort, Bruno Biselli, Silvia Moreira Ayub-Ferreira, Edimar Alcides Bocchi
{"title":"Reversal of Left Bundle Branch Block Following Treatment in Alcoholic Cardiomyopathy.","authors":"Manuela Cristina Ribeiro Dias Barroso, Heleutério da Conceição Nicolau Madogolele, Deborah de Sá Pereira Belfort, Bruno Biselli, Silvia Moreira Ayub-Ferreira, Edimar Alcides Bocchi","doi":"10.36660/abc.20250327","DOIUrl":"10.36660/abc.20250327","url":null,"abstract":"","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 10","pages":"e20250327"},"PeriodicalIF":1.9,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15eCollection Date: 2025-01-01DOI: 10.36660/abc.20250652
Guy F A Prado, Henrique Barbosa Ribeiro
{"title":"Small-Vessel Coronary Disease and Drug-Coated Balloons: Time to Reconsider Our Strategy?","authors":"Guy F A Prado, Henrique Barbosa Ribeiro","doi":"10.36660/abc.20250652","DOIUrl":"10.36660/abc.20250652","url":null,"abstract":"","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 10","pages":"e20250652"},"PeriodicalIF":1.9,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15eCollection Date: 2025-01-01DOI: 10.36660/abc.20250609
Fernanda Almeida Andrade
{"title":"The Hidden Cost of Denied Access: Advanced Heart Failure in Latin America.","authors":"Fernanda Almeida Andrade","doi":"10.36660/abc.20250609","DOIUrl":"10.36660/abc.20250609","url":null,"abstract":"","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 10","pages":"e20250609"},"PeriodicalIF":1.9,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145794979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15eCollection Date: 2025-01-01DOI: 10.36660/abc.20250324
Cassiano Teixeira
In-hospital blood pressure (BP) monitoring often leads to the detection of isolated elevated readings, particularly in the supine position during nighttime checks. However, growing evidence suggests that these transient hypertensive values - frequently labeled as "supine hypertension" - may not warrant pharmacologic intervention in the absence of acute end-organ damage. This opinion piece argues against the reflexive treatment of supine hypertension in hospitalized patients and highlights the risks associated with aggressive management. Excessive monitoring and the lack of contextual interpretation of BP fluctuations may expose patients to unnecessary harm.
{"title":"Treating Numbers or Patients? Rethinking Supine Hypertension in Hospitalized Adults.","authors":"Cassiano Teixeira","doi":"10.36660/abc.20250324","DOIUrl":"10.36660/abc.20250324","url":null,"abstract":"<p><p>In-hospital blood pressure (BP) monitoring often leads to the detection of isolated elevated readings, particularly in the supine position during nighttime checks. However, growing evidence suggests that these transient hypertensive values - frequently labeled as \"supine hypertension\" - may not warrant pharmacologic intervention in the absence of acute end-organ damage. This opinion piece argues against the reflexive treatment of supine hypertension in hospitalized patients and highlights the risks associated with aggressive management. Excessive monitoring and the lack of contextual interpretation of BP fluctuations may expose patients to unnecessary harm.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 9","pages":"e20250324"},"PeriodicalIF":1.9,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15eCollection Date: 2025-01-01DOI: 10.36660/abc.20250542
Paulo Henrique Godoy
{"title":"Alcohol Consumption and Its Association with Lifestyle in Individuals with and without Cardiovascular Disease.","authors":"Paulo Henrique Godoy","doi":"10.36660/abc.20250542","DOIUrl":"10.36660/abc.20250542","url":null,"abstract":"","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 10","pages":"e20250542"},"PeriodicalIF":1.9,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01eCollection Date: 2025-01-01DOI: 10.36660/abc.20250173
Fernando Amaral, Geraldo Luiz Figueiredo, Rafael B Pavão, Paulo Henrique Manso, Luis Gustavo Gali, Danilo Tadao Wada, André Schmidt
{"title":"Adult Congenital Heart Disease. Follow-Up Pattern of Care.","authors":"Fernando Amaral, Geraldo Luiz Figueiredo, Rafael B Pavão, Paulo Henrique Manso, Luis Gustavo Gali, Danilo Tadao Wada, André Schmidt","doi":"10.36660/abc.20250173","DOIUrl":"10.36660/abc.20250173","url":null,"abstract":"","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 9","pages":"e20250173"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12671678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01eCollection Date: 2025-01-01DOI: 10.36660/abc.20250530
Rui Póvoa
{"title":"The Importance of Identifying Phenotypes in Arterial Hypertension.","authors":"Rui Póvoa","doi":"10.36660/abc.20250530","DOIUrl":"10.36660/abc.20250530","url":null,"abstract":"","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 9","pages":"e20250530"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12674841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145727707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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