Nocturnal blood pressure and nighttime dipping patterns are associated with the occurrence of cardiovascular events. However, there is few research on whether riser pattern is associated with the poor prognosis of patients with coronary heart disease (CHD) and hypertension independent of nighttime systolic blood pressure (SBP). This prospective and observational clinical study included 568 hospitalized patients with CHD and hypertension. All patients underwent 24-h ambulatory blood pressure (BP) monitoring during their hospitalization. Multivariate adjusted Cox proportional hazard models were utilized to examine the associations of nocturnal blood pressure and dipping status with primary endpoint events. Additionally, Harrell's C-statistics were employed to compare the discriminative ability of each model. During the 1-year follow-up period, 64 (11.3%) primary endpoint events were recorded, including 55 (9.7%) atherosclerotic cardiovascular disease (ASCVD) events. After adjusting for demographic and clinical risk variables, nighttime SBP was significantly related to the risk of incident primary endpoint events [per 20 mm Hg increase: hazard ratio (HR) = 1.775, 95% confidence interval (CI) 1.256–2.507]. The riser pattern group exhibited a significantly higher risk for primary endpoint events compared to the dipper pattern group, even after adjusting for office SBP (HR: 2.687, 95% CI: 1.015–7.110, p = .047). Furthermore, the addition of nighttime SBP or dipping status to the base model yielded statistically significant increments in C-statistic values (p = .036 and p = .007). However, adding both nighttime SBP and dipping status did not significantly enhance the model's performance in predicting the risk of primary endpoint events and ASCVD events according to the C-index (p = .053 and p = .054), which meant that the riser pattern group did not exhibit a significantly higher risk for primary endpoint events compared to the dipper pattern group after adjusting for nighttime SBP. In conclusion, nocturnal SBP and riser pattern demonstrated an association with adverse prognosis in patients with CHD and hypertension. Notably, nocturnal SBP proved to be a more reliable predictor than dipping status.

中文翻译：

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冠心病合并高血压患者夜间血压表型与不良心血管预后的关系

夜间血压和夜间血压下降模式与心血管事件的发生有关。然而，关于立管模式是否与冠心病（CHD）和高血压患者的不良预后相关（独立于夜间收缩压（SBP））的研究很少。这项前瞻性观察性临床研究纳入了 568 名患有 CHD 和高血压的住院患者。所有患者在住院期间均接受24小时动态血压（BP）监测。利用多变量调整 Cox 比例风险模型来检查夜间血压和血压下降状态与主要终点事件的关联。此外，Harrell 的 C 统计量被用来比较每个模型的判别能力。在 1 年随访期间，记录了 64 起（11.3%）主要终点事件，其中包括 55 起（9.7%）动脉粥样硬化性心血管疾病（ASCVD）事件。调整人口和临床风险变量后，夜间 SBP 与主要终点事件的风险显着相关 [每增加 20 mm Hg：风险比 (HR) = 1.775，95% 置信区间 (CI) 1.256–2.507]。与北斗模式组相比，竖管模式组的主要终点事件风险显着更高，即使在调整办公室 SBP 后也是如此（HR：2.687，95% CI：1.015–7.110，p  = .047）。此外，在基础模型中添加夜间 SBP 或浸渍状态会导致 C 统计值显着增加（p  = .036 和p  = .007）。然而，添加夜间 SBP 和下降状态并没有显着提高模型根据 C 指数（p  = .053 和p  = .054）预测主要终点事件和 ASCVD 事件风险的性能，这意味着上升者在调整夜间收缩压后，与北斗模式组相比，模式组并未表现出显着较高的主要终点事件风险。总之，夜间收缩压和立管模式与冠心病和高血压患者的不良预后相关。值得注意的是，夜间收缩压被证明是比下降状态更可靠的预测指标。