Prognostic superiority of daytime ambulatory over conventional blood pressure in four populations: a meta-analysis of 7,030 individuals
2007 (English)In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 25, no 8, 1554-1564 p.Article in journal (Refereed) Published
Objective To investigate the multivariate-adjusted predictive value of systolic and diastolic blood pressures on conventional (CBP) and daytime (10-20h) 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 (Cl) = 0.96-1.53; P=0.09] for white-coat hypertension (≥140/90 and <135/85 mmHg); 1.62 (95% Cl = 1.35-1.96; P< 0.0001) for masked hypertension (<140/90 and ≥ 135/85 mmHg); and 1.80 (95% Cl = 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.
Place, publisher, year, edition, pages
2007. Vol. 25, no 8, 1554-1564 p.
Ambulatory blood pressure, Cardiovascular disease, Epidemiology, Masked hypertension, White-coat hypertension
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:uu:diva-17245DOI: 10.1097/HJH.0b013e3281c49da5ISI: 000248414400004PubMedID: 17620947OAI: oai:DiVA.org:uu-17245DiVA: diva2:45016