A longitudinal population-based cohort study showed that higher 24-hour and nighttime blood pressure (BP) measurements were significantly associated with greater risks of death and a composite cardiovascular (CV) outcome. The study included 11 135 adults from Europe, Asia, and South America (median age, 54.7 years, 49.3% women) with baseline observations collected from May 1988 to May 2010, 2836 participants died and 2049 experienced a CV event over a median of 13.8 years of follow-up. Both CV mortality and the composite of nonfatal coronary events, heart failure, and stroke were significantly associated with all single systolic BP indexes. For nighttime systolic BP level, the hazard ratio (HR) for total mortality was 1.23 and for CV events, 1.36. For the 24-hour systolic BP level, the HR for total mortality was 1.22 and for CV events, 1.45. With adjustment for any of the other systolic BP indexes, the associations of nighttime and 24-hour systolic BP with the primary outcomes remained statistically significant. Adding any systolic BP index to models already including nighttime or 24-hour systolic BP did not significantly improve model performance. Findings were consistent for diastolic BP. The findings suggest that 24-hour and nighttime BP may be considered optimal measurements for estimating CV risk and could be used to justify treatment of BP that is above the treatment threshold. Source: https://jamanetwork.com/
