Prognostic superiority of daytime ambulatory over conventional blood pressure in four populations: A meta-analysis of 7030 individuals

Tine W. Hansen, Masahiro Kikuya, Lutgarde Thijs, Kristina Björklund-Bodegård, Tatiana Kuznetsova, Takayoshi Ohkubo, Tom Richart, Christian Torp-Pedersen, Lars Lind, Jørgen Jeppesen, Hans Ibsen, Yutaka Imai, Jan A. Staessen

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Abstract

OBJECTIVE: To investigate the multivariate-adjusted predictive value of systolic and diastolic blood pressures on conventional (CBP) and daytime (10-20 h) ambulatory (ABP) measurement. METHODS: We randomly recruited 7030 subjects (mean age 56.2 years; 44.8% women) from populations in Belgium, Denmark, Japan and Sweden. We constructed the International Database on Ambulatory blood pressure and Cardiovascular Outcomes. RESULTS: During follow-up (median = 9.5 years), 932 subjects died. Neither CBP nor ABP predicted total mortality, of which 60.9% was due to noncardiovascular causes. The incidence of fatal combined with nonfatal cardiovascular events amounted to 863 (228 deaths, 326 strokes and 309 cardiac events). In multivariate-adjusted continuous analyses, both CBP and ABP predicted cardiovascular, cerebrovascular, cardiac and coronary events. However, in fully-adjusted models, including both CBP and ABP, CBP lost its predictive value (P ≥ 0.052), whereas systolic and diastolic ABP retained their prognostic significance (P ≤ 0.007) with the exception of diastolic ABP as predictor of cardiac and coronary events (P ≥ 0.21). In adjusted categorical analyses, normotension was the referent group (CBP < 140/90 mmHg and ABP < 135/85 mmHg). Adjusted hazard ratios for all cardiovascular events were 1.22 [95% confidence interval (CI) = 0.96-1.53; P = 0.09] for white-coat hypertension (≥ 140/90 and < 135/85 mmHg); 1.62 (95% CI = 1.35-1.96; P < 0.0001) for masked hypertension (< 140/90 and ≥ 135/85 mmHg); and 1.80 (95% CI = 1.59-2.03; P < 0.0001) for sustained hypertension (≥ 140/90 and ≥ 135/85 mmHg). CONCLUSIONS: ABP is superior to CBP in predicting cardiovascular events, but not total and noncardiovascular mortality. Cardiovascular risk gradually increases from normotension over white-coat and masked hypertension to sustained hypertension.

Original languageEnglish
Pages (from-to)1554-1564
Number of pages11
JournalJournal of hypertension
Volume25
Issue number8
DOIs
Publication statusPublished - 2007 Aug

Keywords

  • Ambulatory blood pressure
  • Cardiovascular disease
  • Epidemiology
  • Masked hypertension
  • White-coat hypertension

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

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    Hansen, T. W., Kikuya, M., Thijs, L., Björklund-Bodegård, K., Kuznetsova, T., Ohkubo, T., Richart, T., Torp-Pedersen, C., Lind, L., Jeppesen, J., Ibsen, H., Imai, Y., & Staessen, J. A. (2007). Prognostic superiority of daytime ambulatory over conventional blood pressure in four populations: A meta-analysis of 7030 individuals. Journal of hypertension, 25(8), 1554-1564. https://doi.org/10.1097/HJH.0b013e3281c49da5