Key result
Every 10-mmHg rise in 24-hour ambulatory SBP predicts ~13% higher mortality, unlike clinic BP.
Why the study?
Although current guidelines recommend ambulatory blood pressure monitoring to confirm hypertension, it remains unclear whether ambulatory or clinic blood pressure measurement is superior in predicting mortality outcomes.
Does 24-hour ambulatory blood pressure monitoring improve the prediction of all-cause and cardiovascular mortality compared to clinic blood pressure measurements?
Meta-Analysis (n=23,140)
Does 24-hour ambulatory blood pressure monitoring improve the prediction of all-cause and cardiovascular mortality compared to clinic blood pressure measurements?
Effect estimate: HR 1.13 (95% CI 1.09-1.18)
24-hour ambulatory blood pressure monitoring is a significantly stronger predictor of both all-cause and cardiovascular mortality compared to standard clinic blood pressure measurements.
Ambulatory BP monitoring may refine mortality risk stratification over clinic measures; leaves open effects on management or outcomes.
Background: According to current clinical practice guidelines, ambulatory blood pres-sure measurement (ABPM) is recommended to confirm diagnoses of hypertension. It remains un-clear as to which method is superior in predicting mortality outcomes. Methods: Prospective observational studies, comparing ABPM with clinical blood pressure meas-urements (CBPM), were included with outcomes of the study being all-cause and cardiovascular mortality. Results: Nine studies with a total of 23,140 participants were included. Each 10-mmHg increase in 24-hour mean systolic blood pressure (SBP) was linked to a higher risk of all-cause mortality (HR: 1.13, 95% CI: 1.09–1.18), while clinic blood pressure measurement (CBPM) was not a sig-nificant predictor (HR: 1.02, 95% CI: 0.90–1.13). Nighttime SBP increases of 10 mmHg were associated with a higher all-cause mortality risk than daytime SBP (HR: 1.16, 95% CI: 1.11–1.21 versus HR: 1.08, 95% CI: 1.05–1.12). For cardiovascular mortality, a 10 mmHg increase in SBP yielded an HR of 1.21 (95% CI: 1.16–1.27) for 24-hour ABPM compared to 1.08 (95% CI: 1.04–1.11) for CBPM. Similarly, for a 5 mmHg increase in diastolic blood pressure (DBP), the HR was 1.14 (95% CI: 1.07–1.20) for 24-hour ABPM versus 1.04 (95% CI: 1.01–1.07) for clinical DBP, highlighting 24-hour monitoring as a stronger predictor for cardiovascular mortality. Conclusion: The findings of this study support the superiority of ABPM measurements in predict-ing both all-cause and cardiovascular mortality.
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Soleimani et al. (2025) conducted a meta-analysis in Hypertension (n=23,140). 24-hour ambulatory blood pressure monitoring (ABPM) vs. Clinic blood pressure measurement (CBPM) was evaluated on All-cause mortality per 10-mmHg increase in systolic blood pressure (HR 1.13, 95% CI 1.09-1.18). A 10-mmHg increase in 24-hour ambulatory systolic blood pressure predicted all-cause mortality (HR 1.13; 95% CI 1.09-1.18), whereas clinic blood pressure measurement did not (HR 1.02).
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