Prediction of stroke by ambulatory blood pressure monitoring versus screening blood pressure measurements in a general population

Ohkubo, Takayoshi; Hozawa, Atsushi; Nagai, Kenichi; Kikuya, Masahiro; Tsuji, Ichiro; Ito, Sadayoshi; Satoh, Hiroshi; Hisamichi, Shigeru; Imai, Yutaka

doi:10.1097/00004872-200018070-00005

Cited by 220 publications

(155 citation statements)

References 26 publications

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“…There is a growing body of evidence, [21][22][23][24] including our previous reports, 8,9,25 that ambulatory BP provides better prognostic value than casual BP, although the median follow-up of all these reports was Ͻ10 years. In the present study, we validated the previous findings using data from long-term follow-up (ie, Ͼ10 years).…”

Section: Rhs (95% Cis) For Bp Values As a Continuous Variablementioning

confidence: 98%

“…Although daytime BP has been reported to be a good predictor of outcomes, 8,[21][22][23][24][25] some studies have shown nighttime BP to be a stronger predictor of cardiovascular mortality. 21,26 The Syst-Eur Trial 21 found that only nighttime BP was a significant predictor of cardiovascular mortality the among placebo and total groups when daytime and nighttime BP were included in the same Cox model.…”

Section: Rhs (95% Cis) For Bp Values As a Continuous Variablementioning

confidence: 99%

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

et al. 2005

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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...

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Section: Rhs (95% Cis) For Bp Values As a Continuous Variablementioning

confidence: 98%

Section: Rhs (95% Cis) For Bp Values As a Continuous Variablementioning

confidence: 99%

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

et al. 2005

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“…In hypertensive patients, the absence of a nocturnal BP dipping has been associated with the development of target organ damage, such as left-ventricular hypertrophy 1 and microalbuminuria, 2 and the occurrence of cerebrovascular 3,4 and cardiovascular events. [5][6][7] In some studies, nighttime BP has been found to be a better predictor of cardiovascular risk and mortality than daytime BP, 8,9 but this observation has not been confirmed in all of the studies.…”

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confidence: 99%

Nighttime Blood Pressure and Nocturnal Dipping Are Associated With Daytime Urinary Sodium Excretion in African Subjects

et al. 2008

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Abstract-Blood pressure (BP) follows a circadian rhythm, with 10% to 15% lower values during nighttime than during daytime. The absence of a nocturnal BP decrease (dipping) is associated with target organ damage, but the determinants of dipping are poorly understood. We assessed whether the nighttime BP and the dipping are associated with the circadian pattern of sodium excretion. Ambulatory BP and daytime and nighttime urinary electrolyte excretion were measured simultaneously in 325 individuals of African descent from 73 families. When divided into sex-specific tertiles of day:night ratios of urinary sodium excretion rate, subjects in tertile 1 (with the lowest ratio) were 6.5 years older and had a 9.8-mm Hg higher nighttime systolic BP (SBP) and a 23% lower SBP dipping (expressed in percentage of day value) compared with subjects in tertile 3 (P for trend Ͻ0.01). After adjustment for age, the SBP difference across tertiles decreased to 5.4 mm Hg (Pϭ0.002), and the SBP dipping difference decreased to 17% (Pϭ0.05). A similar trend across tertiles was found with diastolic BP. In multivariate analyses, daytime urinary sodium and potassium concentrations were independently associated with nighttime SBP and SBP dipping (PϽ0.05 for each). These data, based on a large number of subjects, suggest that the capacity to excrete sodium during daytime is a significant determinant of nocturnal BP and dipping. This observation may help us to understand the pathophysiology and clinical consequences of nighttime BP and to develop therapeutic strategies to normalize the dipping profile in hypertensive patients. (Hypertension. 2008;51:891-898.)

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“…4 -6 So far, only 1 large study has examined the prognostic value of ambulatory BP in a general population, the Ohasama study, conducted in a Japanese population, found future cardiovascular deaths to be better predicted by ambulatory BP than office BP. 7,8 In 1993 to 1994, we recorded ambulatory BP in a random sample of 1700 men and women from the general Danish population. Survival status was recorded until October 2003, allowing us to study the relationship between ambulatory BP and mortality in a general Western population for the first time.…”

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confidence: 99%

Ambulatory Blood Pressure and Mortality

et al. 2005

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Abstract-The relationship between ambulatory blood pressure and mortality in a general Western population is unknown.Therefore, we conducted this prospective study of a random sample of 1700 Danish men and women, aged 41 to 72 years, without major cardiovascular diseases. At baseline, ambulatory blood pressure, office blood pressure, and other risk factors were recorded. After a mean period of 9.5 years, 174 had died: 63 were cardiovascular deaths. In multivariate proportional hazards models, adjusted for other risk factors of significance, the relative risk of cardiovascular mortality (95% confidence interval) associated with 10 mm Hg increments in systolic and 5 mm Hg increments in diastolic ambulatory blood pressure were 1.51 (1.28 to 1.77) and 1.43 (1.26 to 1.61). The corresponding figures for all cause mortality were 1.18 (1.06 to 1.31) and 1.18 (1.09 to 1.28). The relative risks of cardiovascular mortality were lower for office blood pressure, and office blood pressure did not predict all cause mortality. When ambulatory and office blood pressures were entered in the same multivariate models, only the ambulatory blood pressures were significant predictors of all cause mortality and cardiovascular mortality. The relationship between ambulatory blood pressures and risk of mortality was log-linear, with no indication of a threshold. The absolute risk of mortality was also dependent on age and smoking status, and an upper "acceptable" ambulatory blood pressure based on risk of mortality could only be defined when other risk factors were taken into account. In conclusion, ambulatory blood pressure provided prognostic information on mortality above and beyond that of office blood pressure.

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Prediction of stroke by ambulatory blood pressure monitoring versus screening blood pressure measurements in a general population

Cited by 220 publications

References 26 publications

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

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

Nighttime Blood Pressure and Nocturnal Dipping Are Associated With Daytime Urinary Sodium Excretion in African Subjects

Ambulatory Blood Pressure and Mortality

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