24-hour abpm plays an important role in determining cardiovascular prognosis and has been shown to be a better predictor of cardiovascular morbidity and mortality as compared to office blood pressure measurements [ 13 ] .
the objective was to study the relationship between 24  h abpm and cardiovascular outcomes in patients from chesterfield royal hospital .
over 12 months from the 1st of august 2002 , 1187 individuals had 24-hour abpm performed .
these individuals represented a typical spectrum of patients attending for 24  h abpm with blood pressure at different stages and with varying durations of hypertension .  
cardiovascular outcomes were studied in a subset ( 297 ) of the original cohort , made up by every 4th consecutive subject .  
individuals must have one of the recognized indications for 24-hour abpm , as outlined in table 1 .  
every    4th consecutive patient was entered into the study , giving a total of 297 , patients .  
table 2   outlines demographics and blood pressure criteria between the original cohort and the study cohort .  
clinical case notes to study prognostic information were not available from 52 subjects and they were excluded leaving 245 patients .   
				
the following abpm - related prognostic features were studied ( table 3 ) high day time systolic and diastolic bp ( 135 , 85  mmhg ) , high night time systolic and diastolic bp ( 120  mmhg , 75  mmhg ) , absence of nocturnal dip ( 10% fall in night time sbp ) , high early morning sbp ( 140  mmhg ) , and morning surge ( 20/15  mmhg rise in the first two morning readings from 7 am as compared to average night time bp ) .
the cardiovascular outcomes studied ( table 4 ) included fatal and nonfatal mi , new diagnosis of angina , acute coronary syndrome , sudden cardiac death , cardiac arrhythmias , acute lvf , cerebrovascular events , peripheral vascular disease , abdominal aortic aneurysm , and ckd stage 3 or above .
over a followup period of 2015  116 days ( 17202305 days ) 82 cardiovascular events occurred in 61 subjects .
cardiac arrhythmias were the most common cv outcome ( 34 events ) followed by cerebrovascular events ( 15 ) .
statistically significant associations found were between cerebrovascular events and absent nocturnal dip   10% ( p = .05 )   and high day time dbp ( p = .029 ) , peripheral vascular disease and morning surge  20/15  mmhg ( p = .014 ) , cardiac arrhythmias and high day time and night time dbp ( p = .009 and , 033 , resp . ) .
in this study , cardiac arrhythmias were the most commonly observed event accounting for 13.9% of the total events .
atrial fibrillation was the most common cardiac arrhythmia seen in 14/38 ( 52.9% ) patients with cardiac arrhythmias , followed by symptomatic ventricular ectopics in 13 subjects ( 38.2% ) and supraventricular tachycardia and sinoatrial pause in 1 patient each .
it has been shown to be associated with systolic hypertension   and high pulse pressure .
atrial fibrillation may complicate even mildly raised blood pressure , and it would be reasonable to assume that there is no threshold below which the risk of atrial fibrillation is not increased . to the best of our knowledge , our study is the first one to show an increased risk of atrial fibrillation with high day time and night time diastolic blood pressure .  
having said that , one of the recent japanese studies has shown that control of both systolic and diastolic blood pressure is important in reducing risk of new onset atrial fibrillation .   over the years a variety of other risk factors for atrial fibrillation
have been identified such as large left - atrial size , obesity , thyrotoxicosis , and high alcohol .
the exact mechanism for atrial fibrillation in hypertensive subjects   is not understood but is believed to be related to left ventricular hypertrophy and an increase in left - atrial size , left - atrial fibrosis secondary to high systolic blood pressure   and changes in autonomic tone with higher in - treatment heart rate on serial ecgs .
atrial fibrillation is an important cardiovascular risk factor for thromboembolic cardiovascular disease and adds to the existing risk from hypertension itself .
treatment of hypertension exclusively with ace inhibitors , angiotensin - ii - receptor blockers , and beta blockers was shown to be associated with a lower risk of developing atrial fibrillation than current exclusive therapy with calcium - channel blockers . in summary
, our study shows that diastolic hypertension plays an important role in leading to cardiac arrhythmias , in particular atrial fibrillation , and should be treated as vigorously as systolic hypertension .
the study 's main limitation is that it did not take into account presence or absence of other cardiovascular risk factors , such as diabetes mellitus , smoking , hyperlipidaemia , or family history , and has relied entirely on blood pressure criterias .
the authors would like to acknowledge that this may have had bearing on some of the findings .
 
 introduction . 24-hour ambulatory blood pressure monitoring ( abpm ) plays an important role in assessing cardiovascular prognosis , through presence or absence of abpm - related prognostic features . objectives . to study relationship between 24-hour abpm and cardiovascular outcomes in patients from chesterfield royal hospital . 
 material and methods . over 12 months from the 1st of august 2002 , 
 1187 individuals had 24-hour abpm performed . 
 cardiovascular outcomes were studied in a subset ( 297 ) of the original cohort , made up by every 4th consecutive subject . 
 the following abpm - related prognostic features were studied  high day time systolic and diastolic bp ( 135 , 85  mmhg ) , high night time systolic and diastolic bp ( 120  mmhg , 75  mmhg ) , absence of nocturnal dip ( 10% fall in night time sbp ) , high early morning sbp ( 140  mmhg ) , and morning surge ( 20/15  mmhg ) . 
 the cardiovascular outcomes studied in the fourth table included fatal and nonfatal mi , new diagnosis of angina , acute coronary syndrome , sudden cardiac death , cardiac arrhythmias , acute lvf , cerbrovascular events , peripheral vascular disease , abdominal aortic aneurysm , and ckd stage 3 or above . 
 results . over a followup period of 2015  
 116 days ( 17202305 days ) 82 cardiovascular events occurred in 61 subjects . 
 cardiac arrhythmias were the most common cv outcome ( 34 events ) followed by cerebrovascular events ( 15 ) . 
 statistically significant associations found were between cerebrovascular events and absent nocturnal dip  10% ( p = .05 )   and high day time dbp ( p = .029 ) , peripheral vascular disease and morning surge  20/15  mmhg ( p = .014 ) , cardiac arrhythmias and high day time and night time dbp ( p = .009 and .033 , resp . ) . 
 conclusion . 
 significant associations were found between cerebrovascular events and absent nocturnal dip  10% and high day time dbp , peripheral vascular disease and morning surge  20/15  mmhg , cardiac arrhythmias and high day time and night time dbp . 
1. Introduction
2. Objectives
3. Material and Methods
4. Results
5. Discussion