Hypertension. 2005;46:156-161
Published online before print June 6, 2005, doi: 10.1161/01.HYP.0000170138.56903.7a
Published online before print June 6, 2005, doi: 10.1161/01.HYP.0000170138.56903.7a
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(Hypertension. 2005;46:156.)
© 2005 American Heart Association, Inc.
Original Articles |
Superiority of Ambulatory Over Clinic Blood Pressure Measurement in Predicting Mortality
The Dublin Outcome Study
From the ADAPT Centre (E.D., A.S., N.A., S.M., P.M, E.O.) and Blood Pressure Unit, Beaumont Hospital, and Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, Dublin, Ireland; Study Coordinating Centre (L.T., E.D.H., J.A.S.), Laboratory of Hypertension, Hypertension and Cardiovascular Rehabilitation Unit, Department of Molecular and Cardiovascular Research, University of Leuven, Leuven, Belgium; Providence St. Vincent Medical Center (K.H.), Department of Medicine, Portland, Ore.
Correspondence to Eoin O’Brien, ADAPT Centre, Beaumont Hospital, Dublin 9, Ireland. E-mail eobrien{at}iol.ie
The purpose of this study was to determine if ambulatory blood pressure measurement predicted total and cardiovascular mortality over and beyond clinic blood pressure measurement and other cardiovascular risk factors; 5292 untreated hypertensive patients referred to a single blood pressure clinic who had clinic and ambulatory blood pressure measurement at baseline were followed up in a prospective study of mortality outcome. Multiple Cox regression was used to model time to total and cause-specific mortality for ambulatory blood pressure measurement while adjusting for clinic blood pressure measurement and other risk factors at baseline. There were 646 deaths (of which 389 were cardiovascular) during a median follow-up period of 8.4 years. With adjustment for gender, age, risk indices, and clinic blood pressure, higher mean values of ambulatory blood pressure were independent predictors for cardiovascular mortality. The relative hazard ratio for each 10-mm Hg increase in systolic blood pressure was 1.12 (1.06 to 1.18; P<0.001) for daytime and 1.21 (1.15 to 1.27; P<0.001) for nighttime systolic blood pressure. The hazard ratios for each 5-mm Hg increase in diastolic blood pressure were 1.02 (0.99 to 1.07; P=NS) for daytime and 1.09 (1.04 to 1.13; P<0.01) for nighttime diastolic pressures. The hazard ratios for nighttime ambulatory blood pressure remained significant after adjustment for daytime ambulatory blood pressure. These results have 2 important clinical messages: ambulatory measurement of blood pressure is superior to clinic measurement in predicting cardiovascular mortality, and nighttime blood pressure is the most potent predictor of outcome.
Key Words: blood pressure • blood pressure monitoring, ambulatory • cardiovascular diseases • hypertension • mortality
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