Key result
Daytime ambulatory blood pressure was superior to conventional measurement in predicting cardiovascular events, with masked hypertension significantly increasing risk (HR 1.62; 95% CI 1.35-1.96; P<0.0001).
Why the study?
Does daytime ambulatory blood pressure measurement improve prediction of cardiovascular events compared to conventional blood pressure measurement in a general population?
Meta-Analysis (n=7,030)
Yes
Does daytime ambulatory blood pressure measurement improve prediction of cardiovascular events compared to conventional blood pressure measurement in a general population?
Daytime ambulatory blood pressure is superior to conventional blood pressure in predicting cardiovascular events, supporting its use for cardiovascular risk stratification.
Supports incorporating daytime ambulatory BP into routine CV risk evaluation; confirms its superiority for event prediction in meta-analysis.
OBJECTIVE: To investigate the multivariate-adjusted predictive value of systolic and diastolic blood pressures on conventional (CBP) and daytime (10-20 h) ambulatory (ABP) measurement. METHODS: We randomly recruited 7,030 subjects (mean age 56.2 years; 44.8% women) from populations in Belgium, Denmark, Japan and Sweden. We constructed the International Database on Ambulatory blood pressure and Cardiovascular Outcomes. RESULTS: During follow-up (median = 9.5 years), 932 subjects died. Neither CBP nor ABP predicted total mortality, of which 60.9% was due to noncardiovascular causes. The incidence of fatal combined with nonfatal cardiovascular events amounted to 863 (228 deaths, 326 strokes and 309 cardiac events). In multivariate-adjusted continuous analyses, both CBP and ABP predicted cardiovascular, cerebrovascular, cardiac and coronary events. However, in fully-adjusted models, including both CBP and ABP, CBP lost its predictive value (P >or= 0.052), whereas systolic and diastolic ABP retained their prognostic significance (P <or= 0.007) with the exception of diastolic ABP as predictor of cardiac and coronary events (P >or= 0.21). In adjusted categorical analyses, normotension was the referent group (CBP < 140/90 mmHg and ABP < 135/85 mmHg). Adjusted hazard ratios for all cardiovascular events were 1.22 [95% confidence interval (CI) = 0.96-1.53; P = 0.09] for white-coat hypertension (>or= 140/90 and < 135/85 mmHg); 1.62 (95% CI = 1.35-1.96; P < 0.0001) for masked hypertension (< 140/90 and >or= 135/85 mmHg); and 1.80 (95% CI = 1.59-2.03; P < 0.0001) for sustained hypertension (>or= 140/90 and >or= 135/85 mmHg). CONCLUSIONS: ABP is superior to CBP in predicting cardiovascular events, but not total and noncardiovascular mortality. Cardiovascular risk gradually increases from normotension over white-coat and masked hypertension to sustained hypertension.
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Hansen et al. (2007) conducted a meta-analysis in Hypertension (n=7,030). Daytime ambulatory blood pressure (ABP) measurement vs. Conventional blood pressure (CBP) measurement was evaluated on All cardiovascular events (HR 1.62, 95% CI 1.35-1.96, p=< 0.0001). Daytime ambulatory blood pressure was superior to conventional measurement in predicting cardiovascular events, with masked hypertension significantly increasing risk (HR 1.62; 95% CI 1.35-1.96; P<0.0001).
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