Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study

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. We did 24-h blood pressure monitor...

Full description

Saved in:
Bibliographic Details
Published in:The Lancet (British edition) Vol. 370; no. 9594; pp. 1219 - 1229
Main Authors: Boggia, José, Li, Yan, Thijs, Lutgarde, Hansen, Tine W, Kikuya, Masahiro, Björklund-Bodegård, Kristina, Richart, Tom, Ohkubo, Takayoshi, Kuznetsova, Tatiana, Torp-Pedersen, Christian, Lind, Lars, Ibsen, Hans, Imai, Yutaka, Wang, Jiguang, Sandoya, Edgardo, O'Brien, Eoin, Staessen, Jan A
Format: Journal Article
Language:English
Published: London Elsevier Ltd 06.10.2007
Lancet
Elsevier Limited
Subjects:
Accuracy
Aged
Biological and medical sciences
Blood Pressure
Blood Pressure Monitoring, Ambulatory - methods
Blood Pressure Monitoring, Ambulatory - statistics & numerical data
Cardiovascular Diseases - etiology
Cardiovascular Diseases - mortality
Circadian Rhythm
Cohort Studies
Data base management
Diabetes
Female
General aspects
Health risks
Humans
Hypertension
Internal Medicine
Male
Medical research
Medical sciences
Medical technology
MEDICIN
MEDICINE
Middle Aged
Miscellaneous
Population studies
Prognosis
Public health. Hygiene
Public health. Hygiene-occupational medicine
Risk Factors
Studies
Substance abuse treatment
Survival Analysis
Medicine
Accuracy
Prognosis
Night
Cohort study
Arterial pressure
Blood pressure
Hemodynamics
Ambulatory
Comparative study
Public health
ISSN:0140-6736, 1474-547X, 1474-547X
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary: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. 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. 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≥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 (≥0·80 to <0·90). 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.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 14
content type line 23
ISSN:0140-6736
1474-547X
1474-547X
DOI:10.1016/S0140-6736(07)61538-4