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Higher 24-hour, nighttime BP levels significantly associated with greater risk for death
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Higher 24-hour and nighttime measurements of BP — regardless of index used — were significantly associated with greater risk for death and a composite of cardiovascular outcomes in patients from Europe, Asia and South America, according to findings recently published in JAMA.
“Which BP index among the multitude of measurements that can be derived from conventional and ambulatory BP recordings is more closely associated with adverse health outcomes remains unresolved,” Wen-Yi Yang, MD, PhD, of the department of cardiovascular sciences at the University of Leuven in Belgium, and colleagues wrote.
Researchers reviewed BP measurements and cardiovascular outcomes — heart failure, stroke, cardiovascular mortality along with nonfatal coronary events — of 11,135 (median age, 54.7 years; 49.3% women) from a previously existing database. Baseline data collection started in May 1988, and the final follow-up was in October 2016.
Yang and colleagues found that for the 24-hour systolic BP level, the HR for total mortality was 1.22 (95% CI, 1.16-1.28) and the HR for cardiovascular events was 1.45 (95% CI, 1.37-1.54); the HR for nighttime systolic BP was 1.23 (95% CI, 1.17-1.28) and the HR for cardiovascular events was 1.36 (95% CI, 1.3-1.43).
In addition, after adjustment for any other systolic BP index — conventional, automated office systolic BP and daytime — the associations of nighttime and 24-hour systolic BP with the primary outcomes remained statistically significant, with HRs ranging from 1.17 (95% CI, 1.1-1.25) to 1.87 (95% CI, 1.62-2.16). All findings were consistent for diastolic BP, according to researchers.
“Statistically, model improvement compared with other BP indexes was small,” Yang and colleagues concluded.
Philip Greenland, MD, of the departments of preventive medicine and medicine at Northwestern University Feinberg School of Medicine and senior editor of JAMA, provided additional context regarding the clinical relevance of Yang and colleagues’ research in an accompanying editor’s note.
“A systematic review conducted by the U.S. Preventive Services Task Force concluded that ambulatory BP monitoring provided a better method to predict long-term cardiovascular disease outcomes than did office BP measurements. ... However, because ambulatory BP monitoring generates a much larger volume of data than other types of BP measurement, including nighttime BP measurements, it has been uncertain which BP index, or indexes, are more strongly associated with adverse health outcomes,” he wrote. – by Janel Miller
Disclosures: Greenland reports receiving research grants from the NIH and American Heart Association. Yang reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.