Prediction of Coronary and Cerebrovascular Morbidity and Mortality by Direct Continuous Ambulatory Blood Pressure Monitoring in Essential Hypertension

Khattar, Rajdeep; Swales, J. D.; Banfield, Ann; Doré, Caroline J; Senior, Roxy; Lahiri, Avijit

doi:10.1161/01.cir.100.10.1071

Cited by 142 publications

(49 citation statements)

References 25 publications

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“…A number of other studies reported on the night-day BP ratio. Khattar et al 9,16 found in patients with essential hypertension that the nocturnal decline in ABP did not carry independent prognostic information for CVD events. By contrast, Hansen et al 17 observed that the night-day BP ratio was significant for CVD events in subjects with elevated daytime ABP, but not in subjects with normal daytime ABP, and these results persisted after adjustment for 24-h ABP.…”

Section: Discussionmentioning

confidence: 99%

“…These findings therefore suggest that it is warranted to report the results of the four dipping categories separately in this type of studies, whereas several studies only reported on two categories, that is dippers (including extreme dippers) and non-dippers (including reverse dippers). 8,9,16,17 A number of other studies reported on the prognostic significance of the night-day BP ratio or the dipping pattern in hypertensive patients or in the population, but data on the four dipping Figure 2 Hazard ratios and 95% confidence limits for mortality and cardiovascular disease (CVD) events with 24-h blood pressure (BP) and the night-day blood pressure ratio, with stratification for study, simultaneous inclusion of 24-h blood pressure and the night-day blood pressure ratio in the models, and adjustment for age, gender, smoking, total cholesterol, diabetes and antihypertensive treatment. *Pp0.05; w Pp0.01; z Pp0.001.…”

Section: Discussionmentioning

confidence: 99%

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Night–day blood pressure ratio and dipping pattern as predictors of death and cardiovascular events in hypertension

et al. 2009

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Our objective was to assess the prognostic significance of the night-time dipping pattern and the night-day blood pressure (BP) ratio for mortality and cardiovascular events in hypertensive patients without major cardiovascular disease at baseline. We performed a meta-analysis on individual data of 3468 patients from four prospective studies performed in Europe. Age of the subjects averaged 61±13 years; 45% were men and 61% were under antihypertensive treatment at the time of ambulatory BP monitoring. The night-day BP ratio and 24-h BP averaged, respectively, 0.907±0.085/ 0.866±0.095 and 138.1±16.4/82.3±11.0 mm Hg. Total follow-up time amounted to 23 164 patient-years. We used multivariable Cox regression analysis to assess the outcome of reverse dippers, non-dippers and extreme dippers vs dippers, and to assess the hazard ratios associated with 1 standard deviation higher night-day BP ratio. In comparison with dippers, and with adjustment for confounders and 24-h BP, the incidence of cardiovascular events was worse in reverse dippers (Pp0.05), whereas mortality was lower in extreme dippers (Pp0.01); outcome was similar in non-dippers and dippers. The systolic night-day BP ratio independently predicted all-cause mortality and cardiovascular events (Pp0.001), which persisted after additional adjustment for 24-h BP (Pp0.05); appropriate interaction terms indicated that the results were similar in men and women, in younger and older patients and in treated and untreated patients. In conclusion, the dipping pattern and the night-day BP ratio significantly and independently predict mortality and cardiovascular events in hypertensive patients without history of major cardiovascular disease, even after adjustment for 24-h BP.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Night–day blood pressure ratio and dipping pattern as predictors of death and cardiovascular events in hypertension

et al. 2009

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“…Ambulatory BP monitoring (ABPM) is considered the method-of-choice for the diagnosis and therapeutic monitoring of arterial hypertension, 9 and appears to have better prognostic value for the development of cardiovascular and cerebrovascular damage than office blood pressure measurements. 10,11 To the best of our knowledge, no study comparing ABPM in obese with overweight and normal adults with respect to gender has been performed. We thus performed such a study in 27 local clinics in Israel.…”

Section: Introductionmentioning

confidence: 99%

Gender differences in ambulatory blood pressure monitoring profile in obese, overweight and normal subjects

Kagan

Faibel²,

Ben-Arie

et al. 2006

J Hum Hypertens

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The incidence of obesity has increased enormously in the past several decades, and has been described as a modern epidemic. Obesity is a major factor contributing to hypertension. To the best of our knowledge, no study of ambulatory blood pressure monitoring (ABPM) comparing men with women in relation to body mass indexes (BMI) has been performed. From December 2002 to May 2006, we performed 24-h ABPM in 5950 subjects (3102 men and 2848 women), with a wide range of BMI (range 15.9-53.2 kg/m 2 ). We defined obese subjects as those with BMIX30.0 kg/m 2 , overweight subjects as those with BMI425.0 and o30.0 kg/m 2 , and normal subjects as those with BMIp25.0 kg/m 2 . Data on 989 subjects (501 men and 488 women) aged from X18 to p69 years without antihypertensive treatment, atrial fibrillation or diabetes were included for analysis. We consistently found that obese men had the expected increased heart rate compared to normal and overweight men, whereas women (normal, overweight and obese) had similar HRs. In addition, normal and obese women had similar diastolic blood pressures (BP), as opposed to obese men, who had raised diastolic BP. These results may indicate that different pathogenetic mechanisms may be involved in the relationship between obesity and hypertension in men and women.

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“…Ambulatory monitoring is also increasingly used in psychophysiological studies, on the effects of psychosocial factors on the level of BP and HR in everyday settings, for example, the effects of job strain on work and leisure time BP and HR values [4,5]. There is convincing evidence that the predictive value of ambulatory BP is better compared to clinical BP [6,7]. Recent studies brought to attention that HR, an independent predictor of hypertension [8] and cardiovascular disease [9,10], should also be preferably assessed in an ambulatory setting [11].…”

Section: Introductionmentioning

confidence: 99%

Ambulatory heart rate is underestimated when measured by an ambulatory blood pressure device

Vrijkotte

Geus

2001

Journal of Hypertension

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Objective To test the validity of ambulatory heart rate (HR) assessment with a cuff ambulatory blood pressure (ABP) monitor.Design Cross-instrument comparison of HR measured intermittently by a cuff ABP monitor (SpaceLabs, Redmond, Washington, USA), with HR derived from continuous electrocardiogram (ECG) recordings (1) in a controlled laboratory experiment and (2) during long-term recording in a true naturalistic setting.Participants Six normotensive subjects participated in the laboratory study. A total of 109 male white-collar workers underwent ambulatory monitoring, of which 30 were mildly hypertensive.Methods Four different laboratory conditions (postures: lying, sitting, standing, walking), repeated twice, were used to assess the short-term effects of cuff in¯ation on the HR. To test the actual ambulatory validity, participants simultaneously wore a continuous HR recorder and the ABP monitor from early morning to late evening on 2 workdays and one non-workday. Diary and vertical accelerometery information was used to obtain periods of ®xed posture and (physical) activity across which HR from both devices was compared.Results. Laboratory results showed that the ABP device reliably detected HR during blood pressure measurement, but that this HR was systematically lower than the HR directly before and after the blood pressure measurement. The ambulatory study con®rmed this systematic underestimation of the ongoing HR, but additionally showed that its amount increased when subjects went from sitting to standing to light physical activity (2.9; 4.3 and 9.1 bpm (beats/min), respectively). In spite of this activity-dependent underestimation of HR, the correlation of continuous ECG and intermittent ABP-derived HR was high (median r 0.81). Also, underestimation was not different for normotensives and mild hypertensives.Conclusions A direct effect of cuff in¯ation leads to the underestimation of ongoing HR during cuff-based ABP measurement. Additional underestimation of HR occurs during periods with physical activity, probably due to behavioural freezing during blood pressure measurements. HR underestimation was not affected by hypertensive state. When its limitations are taken into account, ABP-derived ambulatory HR can be considered a reliable and valid measure.

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Prediction of Coronary and Cerebrovascular Morbidity and Mortality by Direct Continuous Ambulatory Blood Pressure Monitoring in Essential Hypertension

Abstract: Ambulatory blood pressure is superior to clinic measurement for the assessment of cardiovascular risk; there is no reduction in coronary risk at lower levels of ambulatory diastolic blood pressure.

Cited by 142 publications

References 25 publications

Night–day blood pressure ratio and dipping pattern as predictors of death and cardiovascular events in hypertension

Night–day blood pressure ratio and dipping pattern as predictors of death and cardiovascular events in hypertension

Gender differences in ambulatory blood pressure monitoring profile in obese, overweight and normal subjects

Ambulatory heart rate is underestimated when measured by an ambulatory blood pressure device

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