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).
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.
Effect estimate: HR 1.62 (95% CI 1.35-1.96)
p-value: p=< 0.0001
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= 0.21). In adjusted categorical analyses, normotension was the referent group (CBP or= 140/90 and or= 135/85 mmHg); and 1.80 (95% CI = 1.59-2.03; P 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.
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).