Ambulatory BP More Informative for Mortality

A Spanish observational cohort study indicated that ambulatory blood pressure (BP), particularly night-time BP, was more informative about the risk of all-cause and cardiovascular death than clinic BP. The study used clinic and ambulatory BP data obtained from 59124 patients between March 1, 2004, to Dec 31, 2014. During a median follow-up of 9·7 years, 7174 (12·1%) patients died, including 2361 (4·0%) from cardiovascular causes. Cox models were used to estimate associations between usual clinic or ambulatory BP and mortality. J-shaped associations were observed for several BP measures. Among the top four baseline-defined quintiles, 24-h systolic BP was more strongly associated with all-cause death (hazard ratio [HR] 1·41 per 1 – SD increment) than clinic systolic BP (HR 1·18). The association between 24-h BP with all-cause deaths remained strongly when adjusted for clinic BP (HR 1·43), but the association between clinic BP and all-cause death was attenuated when adjusted for 24-h BP (HR 1·04). Compared with clinic systolic BP (100%), night-time systolic BP was most informative about risk of all-cause death (591%) and cardiovascular death (604%). Relative to BP within the normal range, elevated all-cause and cardiovascular mortality risks were observed for masked hypertension (HR 1·24 and 1.37, respectively) and sustained hypertension (HR 1·24 and 1.38, respectively), but not white-coat hypertension. The study extends findings of previous population and clinical studies and demonstrates the mortality of common BP phenotypes. Source: https://www.thelancet.com/