Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study.
By J. Boggia, Yan Li, L. Thijs, T. Hansen, M. Kikuya, Kristina Björklund-Bodegård, T. Richart, T. Ohkubo, T. Kuznetsova, C. Torp‐Pedersen and 7 more. The Lancet, 2007
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BACKGROUND Few studies have formally compared the predictive value of the blood pressure at night over and beyond the daytime value. We investigated the prognostic significance of the ambulatory blood pressure during night and day and of the night-to-day blood pressure ratio. METHODS We did 24-h blood pressure monitoring in 7458 people (mean age 56.8 years [SD 13.9]) enrolled in prospective population studies in Denmark, Belgium, Japan, Sweden, Uruguay, and China. We calculated multivariate-adjusted hazard ratios for daytime and night-time blood pressure and the systolic night-to-day ratio, while adjusting for cohort and cardiovascular risk factors. FINDINGS Median follow-up was 9.6 years (5th to 95th percentile 2.5-13.7). Adjusted for daytime blood pressure, night-time blood pressure predicted total (n=983; p<0.0001), cardiovascular (n=387; p<0.01), and non-cardiovascular (n=560; p<0.001) mortality. Conversely, adjusted for night-time blood pressure, daytime blood pressure predicted only non-cardiovascular mortality (p<0.05), with lower blood pressure levels being associated with increased risk. Both daytime and night-time blood pressure consistently predicted all cardiovascular events (n=943; p<0.05) and stroke (n=420; p<0.01). Adjusted for night-time blood pressure, daytime blood pressure lost prognostic significance only for cardiac events (n=525; p> or =0.07). Adjusted for the 24-h blood pressure, night-to-day ratio predicted mortality, but not fatal combined with non-fatal events. Antihypertensive drug treatment removed the significant association between cardiovascular events and the daytime blood pressure. Participants with systolic night-to-day ratio value of 1 or more were older, at higher risk of death, and died at an older age than those whose night-to-day ratio was normal (> or =0.80 to <0.90). INTERPRETATION In contrast to commonly held views, daytime blood pressure adjusted for night-time blood pressure predicts fatal combined with non-fatal cardiovascular events, except in treated patients, in whom antihypertensive drugs might reduce blood pressure during the day, but not at night. The increased mortality in patients with higher night-time than daytime blood pressure probably indicates reverse causality. Our findings support recording the ambulatory blood pressure during the whole day.
Subfields: Cardiology and Cardiovascular Medicine, Nutrition and Dietetics
View Paper: https://www.semanticscholar.org/paper/239d7b526e5a509ddf2c6d522ea39fc99512f3cd
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In Cardiology and Cardiovascular Medicine
Citations in the corpus
- Measurement of Blood Pressure in Humans (2019, methodology): “One study reported an increased risk for stroke with extreme dipping versus normal dipping BP, whereas extreme dipping was not associated with increased CVD risk in other studies.(94,144,145)”
- The 2015 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. (2013, methodology): “Out-of-office measures (ambulatory BP monitoring and home BP monitoring) have been shown to have a stronger association with cardiovascular events than office BP measurement.(34,86,91-99) Ambulatory BP monitoring and home BP monitoring have high diagnostic and prognostic ability, and either method c”