The Combination of Non-dipper Heart Rate and High Brain Natriuretic Peptide Predicts Cardiovascular Events: The Japan Morning Surge-Home Blood Pressure (J-HOP) Study.
BACKGROUND
We hypothesized that the association between the dipping heart rate (HR) pattern and cardiovascular (CV) events differs according to the brain natriuretic peptide (BNP) level.


METHODS
We examined a subgroup of 1,369 patients from the Japan Morning Surge Home Blood Pressure study; these were patients who had CV risk factors and had undergone ambulatory blood pressure (BP) monitoring. HR non-dipping status was defined as (awake HR - sleep HR)/awake HR <0.1, and high BNP was defined as ≥35 pg/ml. We divided the patients into four groups according to their HR dipper status (dipping or non-dipping) and BNP level (normal or high).


RESULTS
The mean follow-up period was 60 ± 30 months. The primary endpoints were fatal/nonfatal CV events (myocardial infarction, angina pectoris, stroke, hospitalization for heart failure, and aortic dissection). During the follow-up period, 23 patients (2.8%) in the dipper HR with normal BNP group, 8 patients (4.4%) in the non-dipper HR with normal BNP group, 24 patients (9.5%) in the dipper HR with high-BNP group, and 25 patients (21.0%) in the non-dipper HR with high-BNP group suffered primary endpoints (log rank 78.8, P < 0.001). Non-dipper HR was revealed as an independent predictor of CV events (hazard ratio, 2.13; 95% confidence interval, 1.35-3.36; P = 0.001) after adjusting for age, gender and smoking, dyslipidemia, diabetes mellitus, chronic kidney disease, BNP, non-dipper BP, 24-h HR, and 24-h systolic blood pressure.


CONCLUSIONS
The combination of non-dipper HR and higher BNP was associated with a higher incidence of CV events.
['Ogoyama|Yukako|Y|', 'Kabutoya|Tomoyuki|T|', 'Hoshide|Satoshi|S|', 'Kario|Kazuomi|K|']
D000368:Aged D000369:Aged, 80 and over D015415:Biomarkers D001794:Blood Pressure D002318:Cardiovascular Diseases D002940:Circadian Rhythm D005260:Female D000082742:Heart Disease Risk Factors D006339:Heart Rate D006801:Humans D006973:Hypertension D015994:Incidence D007564:Japan D008297:Male D008875:Middle Aged D020097:Natriuretic Peptide, Brain D011379:Prognosis D018570:Risk Assessment D013997:Time Factors
non-dipper heart rate brain natriuretic peptide cardiovascular event blood pressure hypertension