Ambulatory Blood Pressure and 10-Year Risk of Cardiovascular and Noncardiovascular Mortality

Abstract

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 Ն40 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. Key Words: blood pressure monitoring, ambulatory Ⅲ cardiovascular diseases Ⅲ prospective studies A mbulatory blood pressure (BP) has been used widely to diagnose and evaluate hypertension and to monitor treatment in the clinical setting. 1,2 Moreover, ambulatory BP is known to provide more reproducible information than does casual BP for individual patients with hypertension, 3,4 and is more strongly correlated with target-organ damage than casual BP in hypertensive subjects. Furthermore, the international guidelines for hypertension have emphasized the usefulness of ambulatory BP. 5,6 However, in contrast to the plethora of evidence about casual BP, there is still a lack of data that address the long-term prognostic significance of ambulatory BP. Few longitudinal studies, after Ն10 years, have so far examined the relationship between 24-hour BP and prognosis. Since 1987, we have been conducting a prospective cohort study to investigate the relationship between ambulatory BP and survival in the general population of Ohasama, Japan (the Ohasama Study). [7][8][9] In a previous report, we presented the results from a 5.1-year follow-up period. 8 The objective of the present study was to determine the prognostic significance of ambulatory BP for cardiovascular mortality risk based on a longer follow-up period, o...

Ambulatory pulse pressure as a novel predictor for long-term prognosis in essential hypertensive patients

“…15 Given the potential inaccuracies in measurement technique and artificial increases in BP produced by 'white-coat' effects, 2 office or clinic BP measurement could be inferior to ABPM in predicting hypertension-induced organ damage or clinical outcome. [3][4][5][6] In the current study, office BP parameters including SBP, DBP and even PP failed to predict any clinical outcome. On the other hand, ambulatory BP parameters such as 24 h, daytime and nighttime PP predicted not only CVD and mortality but also non-CV and all-cause mortality, suggesting their broad prognostic impacts in hypertensive patients.…”

“…2 Many studies have confirmed superiority of 24-h ambulatory BP monitoring (ABPM) over office or clinic BP measurement in predicting hypertension-induced organ damage or clinical outcome. [3][4][5][6] To what extent ABPM provides an independent predictive value beyond office BP is of clinical importance, as ABPM is potentially more burdensome and associated with higher costs than office or clinic BP measurements. Previous study mainly focused on ambulatory systolic BP (SBP) 3,4,6,7 or diastolic BP (DBP).…”

“…Further, previous studies were mainly conducted in Europe 3,4,6 and Japan. 5 Both environmental and genetic factors 9 of hypertension may be different among different ethic populations. Given the fact that hypertension is one of the major leading causes of CV events and death in Chinese, this study was conducted to systemically assess the prognostic value of these ABPM parameters on CV morbidity and mortality in an ethnic Chinese population in Taiwan.…”

Genetic influence on blood pressure measured in the office, under laboratory stress and during real life

“…Because ABP is a better predictor of target organ damage, cardiovascular morbidity and mortality than office BP, 6–8 it is of great interest to know whether 24-h BP will be a better phenotype than office BP to find genes for EH. To date, four twin studies 25–28 and three family studies 29–31 have reported heritability estimates for 24-h ABP recording.…”

“…5 The added value of ABP measurements has indeed been illustrated by studies showing that ABP is a better predictor of target organ damage and cardiovascular morbidity and mortality than BP measured in the clinic. 6–8 …”