Ewha Med J.  2023 Jul;46(3):e6. 10.12771/emj.2023.e6.

Prognostic Significance of 24-Hour Ambulatory Blood Pressure and Holter Monitoring in Patients without Atrial Fibrillation

• Park S
• Park J
• Choi Y
• Shin S
• Park J

• KMID: 2545171
• DOI: http://doi.org/10.12771/emj.2023.e6

Abstract

Objectives
This study investigated the 24-hour ambulatory blood pressure monitoring (ABPM) and Holter parameters for evaluating their prognostic significance of cardiovascular events including stroke in population without atrial fibrillation (AF).
Methods
Among 3,199 patients that underwent ABPM, 335 who also underwent Holter recordings were selected in a tertiary hospital. Seventeen patients who had been documented with AF on Holter monitoring or diagnosed with AF were excluded, and finally 318 patients were analyzed. The association between cardiovascular events and ABPM/Holter parameters was analyzed by a logistic regression model, and the risk factors were estimated by a Cox hazard model. Age, sex, and histories of cardiovascular disease were adjusted by a multivariable analysis, and the cut-off values were suggested by a Kaplan-Meyer analysis.
Results
During the total follow-up (28.5±1.7 months), 13 (4.1%) stroke, 6 (1.9%) heart failure, and 12 (3.8%) acute coronary syndrome incidences were observed. In the univariate analysis of the ABPM parameters, an increment in the night systolic BP (hazard ratio=1.034, P=0.020) and night diastolic BP (hazard ratio=1.063, P=0.031) significantly elevated the risk of a stroke occurrence. According to the Kaplan-Meyer analysis, there was a significant difference in the stroke incidence between the groups divided by a cut-off value of the night systolic BP of 120 mmHg (P=0.014) and night diastolic BP of 75 mmHg (P=0.023).
Conclusion
In a population without AF, the nocturnal BP was a significant predictor of a stroke incidence. At this point, the cut-off value of mean 120/75 mmHg in 24 ABPM was advisable.

Keyword

Blood pressure monitoring; ambulatory; Holter; Cardiovascular diseases; Stroke

Figure

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  Fig. 1. Study design. By screening 3,199 patients who received 24 hr ABPM, 335 patients who also participated in Holter monitoring were enrolled. After excluding 17 patients with documented AF, 318 patients were eligible for the study analysis. ABPM, ambulatory blood pressure monitoring; AF, atrial fibrillation.

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  Fig. 2. Fraction survival free from strokes according to the cutoff value of the nighttime BP. (A) By a Kaplan-Meyer analysis, the significant difference in the stroke incidence between the groups divided by the cut-off value was a nighttime sBP of 120 mmHg. (B) In the case of the nighttime dBP, 75 mmHg was a significant cut-off value. (C) Also both the nighttime BP cut-off values of 120/75 mmHg were significant. SBP, systolic blood pressure; DBP, diastolic blood pressure; BP, blood pressure.

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  Fig. 3. Stroke incidence according to the nighttime BP cut-off value. The data of the 318 patients are distributed based on the nighttime sBP/dBP (mmHg). Nine patients with an occurrence of a stroke are marked as red boxes, and the grey circles mean the patients without a stroke. The cut-off of 120/75 mmHg was suggested by the Kaplan Meier survival analysis (P=0.006). BP, blood pressure; sBP, systolic blood pressure; dBP, diastolic blood pressure.

Reference

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