The Predictive Role of the Nighttime Blood Pressure: 4a.02

Objective: [1] To derive precise estimates for the association between outcome and ABPM during sleep as reflected by the nocturnal SBP level, the night-to-day SBP ratio (sNDR), or dipping status. [2] To evaluate the influence of accounting for BP level on the strength of these associations. Design and methods: We did a meta-analysis of summary statistics extracted from prospective studies in hypertensive patients (16 studies; 23856 patients; 1816 cases of total mortality [TM]; 1259 CV events [CVE]). We also computed pooled estimates, using individual subject data from 11 population studies (9641 patients; 1320 cases of TM; 1128 CVE). We pooled hazard ratios using the PROC MIXED procedure (SAS, 9.1.3). Results:All hazard ratios (95% CI) were adjusted. Fully adjusted (FA) refers to models in which risk estimates based on daytime SBP were additionally adjusted for nighttime SBP (and vice versa), or in which risk estimates based on the sNDR or dipping status were also adjusted for the 24-h SBP. * P≤0.05; †P≤0.01; ‡P≤0.001. Conclusions: [1] Nighttime SBP is a stronger predictor than daytime SBP. [2] sNDR predicts outcome over and beyond 24-h SBP. These findings strongly support the recommendations to record BP over the whole day for risk stratification in clinical practice.