Ambulatory blood pressure and 10-year risk of cardiovascular and noncardiovascular mortality: The Ohasama study

Masahiro Kikuya, Takayoshi Ohkubo, Kei Asayama, Hirohito Metoki, Taku Obara, Shin Saito, Junichiro Hashimoto, Kazuhito Totsune, Haruhisa Hoshi, Hiroshi Satoh, Yutaka Imai

Research output: Contribution to journalArticlepeer-review

339 Citations (Scopus)

Abstract

The objective of this study was to elucidate the long-term prognostic significance of ambulatory blood pressure. Ambulatory and casual blood pressure values were obtained from 1332 subjects (872 women and 460 men) aged ≥40 years from the general population of a rural Japanese community. Survival was then followed for 14 370 patient years and analyzed by a Cox hazard model adjusted for possible confounding factors. There were 72 cardiovascular deaths during the 10.8-year follow-up. The relationship between 24-hour systolic blood pressure and the cardiovascular mortality risk was U-shaped in the first 5 years, then changed to J-shaped over the rest of the 10.8-year follow-up. After censoring the first 2 years of data, the risk flattened until it again increased for the fifth quintile of 24-hour systolic blood pressure for the 10.8-year follow-up period. For 24-hour diastolic blood pressure, the J-shaped relationship remained unchanged, regardless of follow-up duration and censoring. Ambulatory systolic blood pressure values consistently showed stronger predictive power for cardiovascular mortality risk than did casual systolic blood pressure in the 10.8-year follow-up data, whereas such relationships became more marked after censoring the first 2 years. When nighttime and daytime systolic blood pressure values were simultaneously included in the same Cox model, only nighttime blood pressure significantly predicted the cardiovascular mortality risk for the 10.8-year follow-up data. We conclude that the relationship between ambulatory systolic blood pressure and cardiovascular mortality is not U-shaped or J-shaped, and that nighttime blood pressure has better prognostic value than daytime blood pressure.

Original languageEnglish
Pages (from-to)240-245
Number of pages6
JournalHypertension
Volume45
Issue number2
DOIs
Publication statusPublished - 2005 Feb

Keywords

  • Blood pressure monitoring, ambulatory
  • Cardiovascular diseases
  • Prospective studies

ASJC Scopus subject areas

  • Internal Medicine

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