Prognostic value of isolated nocturnal hypertension on ambulatory measurement in 8711 individuals from 10 populations (original) (raw)
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Early prognostic value of nocturnal blood pressure
Blood Pressure Monitoring, 2019
Ambulatory blood pressure monitoring (ABPM) is now considered by current guidelines to be a reliable method of measurement for the diagnosis and assessment of hypertension. The aim of this study was to relate the shortterm outcomes, comorbidity and ABPM findings determined from evaluating an everyday clinical cohort of hypertensive patients. A prospective study was carried out that included hypertensive patients who had undergone 24-h ABPM from January 2016 to November 2017. The following parameters were recorded in the database: age, sex, current antihypertensive treatment and documented history of comorbidities. New episodes of myocardial infarction and stroke requiring hospitalization during follow-up obtained from electronic medical records were considered to be major adverse cardiovascular events (MACE) and were our main outcome measures. To estimate the risk of MACE, a Cox multivariate analysis was carried out. We analysed 1521 ABPM values and recorded 33 MACE during a follow-up of 518 ± 120 days; 15 patients suffered a myocardial infarction and 18 patients had a stroke. The mean age of the patients was 59.9 ± 14.2 years, and 49.4% were men. Night-time systolic blood pressure (BP), mean BP and pulse pressure were higher in patients who suffered a MACE. Age [hazard ratio (HR): 1.031, 95% confidence interval (CI): 1.002-1.060; P = 0.036], night-time BP (HR: 1.018, 95% CI: 1.001-1.037; P = 0.044) and diabetes mellitus (HR: 2.393, 95% CI: 1.053-5.436; P = 0.037) were associated independently with MACE. We conclude that night-time BP is an important parameter to evaluate in aged patients with diabetes as a predictor of MACE.
Journal of Hypertension, 2004
OBJECTIVES: To assess the relationship between office and ambulatory systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) and total mortality in elderly patients with hypertension. DESIGN: Observational prospective cohort study. SETTING: Hypertension outpatient clinic in a geriatric academic hospital. PATIENTS AND METHODS: Eight hundred five older ( !60) subjects with hypertension underwent office and ambulatory BP measurement. Mortality was assessed after a mean follow-up of 3.8 years. RESULTS: In a total of 3,090 person-years of follow-up, 107 participants died (average mortality rate 3.5% per year). With bivariate analysis, participants who died had higher SBP and PP and lower DBP, with office and ambulatory measurements. Mortality rates were greater with higher SBP and lower with higher DBP. As a combined effect of these trends, PP was associated with the widest death rate gradients, from 12 to 66, 13 to 63, and 9 to 70 per 1,000 person-years across office, 24-hour, daytime, and nighttime PP quartiles, respectively. Multivariate Cox analysis confirmed these trends; the adjusted hazard of death increased linearly with increasing ambulatory SBP and PP, whereas it decreased significantly with increasing ambulatory DBP. A five times greater risk of death was detected when comparing night-time PP quartile 4 (median PP value 78 mmHg) with quartile 1 (median PP value 46 mmHg). CONCLUSION: In older patients with hypertension, low DBP and high PP, particularly when measured using ambulatory BP monitoring, are associated with greater risk of death. The achievement of an SBP treatment goal should not be obtained at the expense of an excessive DBP reduction. J Am Geriatr Soc 57:291-296, 2009. Po à .05, Ãà .001 vs alive. SD 5 standard deviation; HR 5 heart rate; SBP 5 systolic blood pressure; DBP 5 diastolic blood pressure; PP 5 pulse pressure.
Interpretation of Ambulatory Blood Pressure Profile for Risk Stratification: Keep It Simple
Hypertension, 2014
A solid body of evidence supports the contention that cardiovascular morbidity and mortality are better predicted by ambulatory blood pressure (BP) than by BP measured in the physician's office. 1 Compared with office BP, the main advantage of ambulatory BP monitoring (ABPM) is the number of readings obtained throughout a 24-hour period. Frequent readings during wakefulness and sleep enable clinicians to obtain a more precise estimation of a patient's BP, to assess BP levels in the outpatient setting, and to study BP variability and circadian profile.
Nighttime Blood Pressure Phenotype and Cardiovascular Prognosis
Circulation
Background: Ambulatory and home blood pressure (BP) monitoring parameters are better predictors of cardiovascular events than are office BP monitoring parameters, but there is a lack of robust data and little information on heart failure (HF) risk. The JAMP study (Japan Ambulatory Blood Pressure Monitoring Prospective) used the same ambulatory BP monitoring device, measurement schedule, and diary-based approach to data processing across all study centers and determined the association between both nocturnal hypertension and nighttime BP dipping patterns and the occurrence of cardiovascular events, including HF, in patients with hypertension. Methods: This practitioner-based, nationwide, multicenter, prospective, observational study included patients with at least 1 cardiovascular risk factor, mostly hypertension, and free of symptomatic cardiovascular disease at baseline. All patients underwent 24-hour ambulatory BP monitoring at baseline. Patients were followed annually to determin...
Hypertension, 2005
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. (Hypertension. 2005;45:240-245.)
The Journal of Clinical Hypertension, 2010
To evaluate the long-term prognostic significance of different ranges of the percentage fall in nighttime blood pressure (BP) of the nondipping pattern, 1200 hypertensive patients 645 women, age 51AE12 years) underwent ambulatory BP monitoring under stabilized therapy. The occurrence of cardiovascular (CV) events was followed for 9833 patient-years and analyzed by the Cox hazard model. There were 152 CV fatal ⁄ nonfatal events (79 strokes, 51 coronary events, 22 others) during the 15.2 years of follow-up. According to nighttime BP fall (%) the authors noted: <0% (reverse-dippers [RD], n=83); 0%-4.9% (nondippers 1 [ND1], n=207); 5%-9.9% (nondippers 2 [ND2], n=311), 10%-19.9% (dippers [D], n=523); and !20% (extreme dippers [ED], n=76). After adjustment for confounding variables, hazard ratios (95% confidence interval) of CV event and stroke in RD vs D were 2.29 (1.31-3.99) and 2.46 (1.11-5.49); of ND1 vs D were 1.42 (1.12-1.79) and 1.62 (1.17-2.23); and of ND1 vs ND2 were 2.24 (1.33-3.75) and 2.30 (1.15-4.58). No differences were found in RD vs ND1 and ND2 vs D. Nondippers have a higher CV risk than dippers but only for a nighttime BP fall <5% suggesting that the limits for nondipping should be redefined for a stratification of CV risk. J Clin Hypertens (Greenwich). 2010;12:508-515. ª 2010 Wiley Periodicals, Inc.