Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly XXXX : a prospective study.

@entity1 @entity64 @entity101 @entity1188 @entity551
BACKGROUND: Cardiovascular events occur most frequently in the morning hours. We prospectively studied the association between the morning blood pressure (BP) surge and @entity64 in elderly @entity101 . METHODS AND RESULTS: We studied @entity64 prognosis in 519 older @entity101 in whom ambulatory BP monitoring was performed and silent cerebral @entity1188 was assessed by brain MRI and who were followed up prospectively. The @entity551 ( @entity551 ) was calculated as follows: mean systolic BP during the 2 hours after awakening minus mean systolic BP during the 1 hour that included the lowest sleep BP. During an average duration of 41 months (range 1 to 68 months), 44 @entity64 events occurred. When the @entity1 were divided into 2 groups according to @entity551 , those in the top decile ( @entity551 group; @entity551 > or =55 mm Hg, n=53) had a higher baseline prevalence of @entity1188 (57% versus 33%, P=0.001) and a higher @entity64 incidence (19% versus 7.3%, P=0.004) during the follow-up period than the others (non- @entity551 group; @entity551 <55 mm Hg, n=466). After they were matched for age and 24-hour BP, the relative risk of the @entity551 group versus the non- @entity551 group remained significant (relative risk=2.7, P=0.04). The @entity551 was associated with @entity64 events independently of 24-hour BP, nocturnal BP dipping status, and baseline prevalence of silent @entity1188 (P=0.008). CONCLUSIONS: In older @entity101 , a higher @entity551 is associated with @entity64 risk independently of ambulatory BP, nocturnal BP falls, and silent @entity1188 . Reduction of the @entity551 could thus be a new therapeutic target for preventing target organ damage and subsequent cardiovascular events in @entity101 @entity1 .
