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...
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| Veröffentlicht in: | The Lancet (British edition) Jg. 370; H. 9594; S. 1219 - 1229 |
|---|---|
| Hauptverfasser: | , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
London
Elsevier Ltd
06.10.2007
Lancet Elsevier Limited |
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| ISSN: | 0140-6736, 1474-547X, 1474-547X |
| Online-Zugang: | Volltext |
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| Abstract | 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. |
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| AbstractList | 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. 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.BACKGROUNDFew 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.METHODSWe 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> 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).FINDINGSMedian 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).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.INTERPRETATIONIn 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. [...] in cohorts of patients with hypertension, antihypertensive drug treatment attenuated the association between outcome and blood pressure.7 An international consortium constructed a database of prospective population studies with the goal to advance research on the prognostic accuracy of the ambulatory blood pressure.13,14 We aimed to report risk estimates that were independently associated with the daytime and night-time blood pressures. Methods Study population We constructed the International Database on Ambulatory blood pressure monitoring in relation to Cardiovascular Outcomes (IDACO).13,14 Studies were eligible for inclusion if they included a random population sample, if information about the conventional and ambulatory blood pressures and cardiovascular risk factors were available at baseline, and if the subsequent follow-up included fatal and non-fatal outcomes. 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> 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). 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. Summary 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≥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). 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. 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 >= 0.07). Adjusted for the 24-h blood pressure, night-to-day ratio predicted mortality, but not fatal combined with non-fatal events. Antohypertensive 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). 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. |
| Author | Ibsen, Hans Ohkubo, Takayoshi Boggia, José Björklund-Bodegård, Kristina Thijs, Lutgarde Sandoya, Edgardo Torp-Pedersen, Christian Imai, Yutaka Staessen, Jan A O'Brien, Eoin Lind, Lars Li, Yan Hansen, Tine W Richart, Tom Wang, Jiguang Kikuya, Masahiro Kuznetsova, Tatiana |
| Author_xml | – sequence: 1 givenname: José surname: Boggia fullname: Boggia, José organization: Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay – sequence: 2 givenname: Yan surname: Li fullname: Li, Yan organization: Center for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China – sequence: 3 givenname: Lutgarde surname: Thijs fullname: Thijs, Lutgarde organization: Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium – sequence: 4 givenname: Tine W surname: Hansen fullname: Hansen, Tine W organization: Research Center for Prevention and Health, Copenhagen, Denmark – sequence: 5 givenname: Masahiro surname: Kikuya fullname: Kikuya, Masahiro organization: Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai, Japan – sequence: 6 givenname: Kristina surname: Björklund-Bodegård fullname: Björklund-Bodegård, Kristina organization: Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden – sequence: 7 givenname: Tom surname: Richart fullname: Richart, Tom organization: Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium – sequence: 8 givenname: Takayoshi surname: Ohkubo fullname: Ohkubo, Takayoshi organization: Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai, Japan – sequence: 9 givenname: Tatiana surname: Kuznetsova fullname: Kuznetsova, Tatiana organization: Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium – sequence: 10 givenname: Christian surname: Torp-Pedersen fullname: Torp-Pedersen, Christian organization: Copenhagen University Hospital, Copenhagen, Denmark – sequence: 11 givenname: Lars surname: Lind fullname: Lind, Lars organization: Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden – sequence: 12 givenname: Hans surname: Ibsen fullname: Ibsen, Hans organization: Copenhagen University Hospital, Copenhagen, Denmark – sequence: 13 givenname: Yutaka surname: Imai fullname: Imai, Yutaka organization: Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai, Japan – sequence: 14 givenname: Jiguang surname: Wang fullname: Wang, Jiguang organization: Center for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China – sequence: 15 givenname: Edgardo surname: Sandoya fullname: Sandoya, Edgardo organization: Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay – sequence: 16 givenname: Eoin surname: O'Brien fullname: O'Brien, Eoin organization: Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland – sequence: 17 givenname: Jan A surname: Staessen fullname: Staessen, Jan A email: jan.staessen@med.kuleuven.be organization: Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19112668$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/17920917$$D View this record in MEDLINE/PubMed https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-17332$$DView record from Swedish Publication Index (Uppsala universitet) |
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| Snippet | Few studies have formally compared the predictive value of the blood pressure at night over and beyond the daytime value. We investigated the prognostic... Summary Background Few studies have formally compared the predictive value of the blood pressure at night over and beyond the daytime value. We investigated... [...] in cohorts of patients with hypertension, antihypertensive drug treatment attenuated the association between outcome and blood pressure.7 An... Background Few studies have formally compared the predictive value of the blood pressure at night over and beyond the daytime value. We investigated the... |
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| SubjectTerms | 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 |
| Title | Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study |
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