Predicting Cardiovascular Risk Using Conventional vs Ambulatory Blood Pressure in Older Patients With Systolic Hypertension
Abstract
CONTEXT: The clinical use of ambulatory blood pressure (BP) monitoring requires further validation in prospective outcome studies. OBJECTIVE: To compare the prognostic significance of conventional and ambulatory BP measurement in older patients with isolated systolic hypertension. DESIGN: Substudy to the double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) Trial, started in October 1988 with follow up to February 1999. The conventional BP at randomization was the mean of 6 readings (2 measurements in the sitting position at 3 visits 1 month apart). The baseline ambulatory BP was recorded with a noninvasive intermittent technique. SETTING: Family practices and outpatient clinics at primary and secondary referral hospitals. PARTICIPANTS: A total of 808 older (aged > or =60 years) patients whose untreated BP level on conventional measurement at baseline was 160 to 219 mm Hg systolic and less than 95 mm Hg diastolic. INTERVENTIONS: For the overall study, patients were randomized to nitrendipine (n = 415; 10-40 mg/d) with the possible addition of enalapril (5-20 mg/d) and/or hydrochlorothiazide (12.5-25.0 mg/d) or to matching placebos (n = 393). MAIN OUTCOME MEASURES: Total and cardiovascular mortality, all cardiovascular end points, fatal and nonfatal stroke, and fatal and nonfatal cardiac end points. RESULTS: After adjusting for sex, age, previous cardiovascular complications, smoking, and residence in western Europe, a 10-mm Hg higher conventional systolic BP at randomization was not associated with a worse prognosis, whereas in the placebo group, a 10-mm Hg higher 24-hour BP was associated with an increased relative hazard rate (HR) of most outcome measures (eg, HR, 1.23 [95% confidence interval [CI], 1.00-1.50] for total mortality and 1.34 [95% CI, 1.03-1.75] for cardiovascular mortality). In the placebo group, the nighttime systolic BP (12 AM-6 AM) more accurately predicted end points than the daytime level. Cardiovascular risk increased with a higher night-to-day ratio of systolic BP independent of the 24-hour BP (10% increase in night-to-day ratio; HR for all cardiovascular end points, 1.41; 95% CI, 1.03-1.94). At randomization, the cardiovascular risk conferred by a conventional systolic BP of 160 mm Hg was similar to that associated with a 24-hour daytime or nighttime systolic BP of 142 mm Hg (95% CI, 128-156 mm Hg), 145 mm Hg (95% CI, 126-164 mm Hg) or 132 mm Hg (95% CI, 120-145 mm Hg), respectively. In the active treatment group, systolic BP at randomization did not significantly predict cardiovascular risk, regardless of the technique of BP measurement. CONCLUSIONS: In untreated older patients with isolated systolic hypertension, ambulatory systolic BP was a significant predictor of cardiovascular risk over and above conventional BP.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Some but not all studies have suggested that nighttime blood pressure is the strongest predictor of death.
“Some 4,6,9,11 but not all studies 5,10 have suggested that nighttime blood pressure is the strongest predictor of death.”
From Relationship between clinic and ambulatory blood pressure and mortality: an observational cohort study in 59 124 patients (2023) · cites this paper as [9]
The superiority of nighttime blood pressure over daytime blood pressure has been observed in other previous studies.
“The superiority of nighttime blood pressure over daytime blood pressure has been observed in other previous studies, 4,9,11,13,14,35,36”
From Relationship between clinic and ambulatory blood pressure and mortality: an observational cohort study in 59 124 patients (2023) · cites this paper as [9]
Cited by
Sorted by citations
Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L., Jones, D. W., Materson, B. J., Oparil, S., Wright, J. T., et al. (2003) · Hypertension · doi:10.1161/01.hyp.0000107251.49515.c2 · Cited by 13,271 · see citing works
Pickering, T. G., Hall, J. E., Appel, L. J., Falkner, B. E., Graves, J., Hill, M. N., Jones, D. W., Kurtz, T., Sheps, S. G., & Roccella, E. J. (2005) · Circulation · doi:10.1161/01.cir.0000154900.76284.f6 · Cited by 3,985 · see citing works
2024 ESC Guidelines for the management of elevated blood pressure and hypertension
McEvoy, J. W., McCarthy, C. P., Bruno, R. M., Brouwers, S., Canavan, M. D., Ceconi, C., Christodorescu, R. M., Daskalopoulou, S. S., Ferro, C. J., Gerdts, E., et al. (2024) · European Heart Journal · doi:10.1093/eurheartj/ehae178 · Cited by 2,298 · see citing works
Self-citationPickering, T. G., Hall, J. E., Appel, L. J., Falkner, B. E., Graves, J., Hill, M. N., Jones, D. W., Kurtz, T., Sheps, S. G., & Roccella, E. J. (2005) · Hypertension · doi:10.1161/01.hyp.0000150859.47929.8e · Cited by 2,051 · see citing works
O'Brien, E., Asmar, R., Beilin, L., Imai, Y., Mallion, J.-M., Mancia, G., Mengden, T., Myers, M., Padfield, P., Palatini, P., et al. (2003) · Journal of Hypertension · doi:10.1097/00004872-200305000-00001 · Cited by 1,655 · see citing works
Self-citationEuropean Society of hypertension position paper on ambulatory blood pressure monitoring
O’Brien, E., Parati, G., Stergiou, G., Asmar, R., Beilin, L., Bilo, G., Clement, D., de la Sierra, A., de Leeuw, P., Dolan, E., et al. (2013) · Journal of Hypertension · doi:10.1097/hjh.0b013e328363e964 · Cited by 1,419 · see citing works
Self-citationDolan, E., Stanton, A., Thijs, L., Hinedi, K., Atkins, N., McClory, S., Hond, E. D., McCormack, P., Staessen, J. A., & O’Brien, E. (2005) · Hypertension · doi:10.1161/01.hyp.0000170138.56903.7a · Cited by 1,227 · see citing works
Self-citationAssessment and management of blood-pressure variability
Parati, G., Ochoa, J. E., Lombardi, C., & Bilo, G. (2013) · Nature Reviews Cardiology · doi:10.1038/nrcardio.2013.1 · Cited by 853 · see citing works
Lackland, D. T., Roccella, E. J., Deutsch, A. F., Fornage, M., George, M. G., Howard, G., Kissela, B. M., Kittner, S. J., Lichtman, J. H., Lisabeth, L. D., et al. (2014) · Stroke · doi:10.1161/01.str.0000437068.30550.cf · Cited by 815 · see citing works
de la Sierra, A., Segura, J., Banegas, J. R., Gorostidi, M., de la Cruz, J. J., Armario, P., Oliveras, A., & Ruilope, L. M. (2011) · Hypertension · doi:10.1161/hypertensionaha.110.168948 · Cited by 809 · see citing works
Hermida, R. C., Ayala, D. E., Mojón, A., & Fernández, J. R. (2010) · Chronobiology International · doi:10.3109/07420528.2010.510230 · Cited by 608 · see citing works
Rabi, D. M., McBrien, K. A., Sapir-Pichhadze, R., Nakhla, M., Ahmed, S. B., Dumanski, S. M., Butalia, S., Leung, A. A., Harris, K. C., Cloutier, L., et al. (2020) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2020.02.086 · Cited by 583 · see citing works
RETRACTED: Relationship between Clinic and Ambulatory Blood-Pressure Measurements and Mortality
Banegas, J. R., Ruilope, L. M., de la Sierra, A., Vinyoles, E., Gorostidi, M., de la Cruz, J. J., Ruiz-Hurtado, G., Segura, J., Rodríguez-Artalejo, F., & Williams, B. (2018) · New England Journal of Medicine · doi:10.1056/nejmoa1712231 · Cited by 490 · see citing works
RetractedEmpagliflozin Reduces Blood Pressure in Patients With Type 2 Diabetes and Hypertension
Tikkanen, I., Narko, K., Zeller, C., Green, A., Salsali, A., Broedl, U. C., & Woerle, H. J. (2015) · Diabetes Care · doi:10.2337/dc14-1096 · Cited by 468 · see citing works
Mobile monitoring with wearable photoplethysmographic biosensors
Asada, H. H., Shaltis, P., Reisner, A., Rhee, S., & Hutchinson, R. C. (2003) · IEEE Engineering in Medicine and Biology Magazine · doi:10.1109/memb.2003.1213624 · Cited by 466 · see citing works
Daily nighttime melatonin reduces blood pressure in male patients with essential hypertension
Scheer, F. A. J. L., Van Montfrans, G. A., van Someren, E. J. W., Mairuhu, G., & Buijs, R. M. (2004) · Hypertension · doi:10.1161/01.hyp.0000113293.15186.3b · Cited by 451 · see citing works
Ernst, M. E., Carter, B. L., Goerdt, C. J., Steffensmeier, J. J. G., Phillips, B. B., Zimmerman, M. B., & Bergus, G. R. (2006) · Hypertension · doi:10.1161/01.hyp.0000203309.07140.d3 · Cited by 433 · see citing works
Prevalence and Factors Associated With Circadian Blood Pressure Patterns in Hypertensive Patients
de la Sierra, A., Redon, J., Banegas, J. R., Segura, J., Parati, G., Gorostidi, M., de la Cruz, J. J., Sobrino, J., Llisterri, J. L., Alonso, J., et al. (2009) · Hypertension · doi:10.1161/hypertensionaha.108.124008 · Cited by 379 · see citing works
Hodgkinson, J., Mant, J., Martin, U., Guo, B., Hobbs, F. D. R., Deeks, J. J., Heneghan, C., Roberts, N., & McManus, R. J. (2011) · BMJ · doi:10.1136/bmj.d3621 · Cited by 370 · see citing works
Fagard, R. H., Thijs, L., Staessen, J. A., Clement, D. L., De Buyzere, M. L., & De Bacquer, D. A. (2009) · Journal of Human Hypertension · doi:10.1038/jhh.2009.9 · Cited by 324 · see citing works
Self-citationPrognostic Influence of Office and Ambulatory Blood Pressures in Resistant Hypertension
Salles, G. F., Cardoso, C. R. L., & Muxfeldt, E. S. (2008) · Archives of Internal Medicine · doi:10.1001/archinte.168.21.2340 · Cited by 293 · see citing works
Staessen, J. A. (2004) · JAMA · doi:10.1001/jama.291.8.955 · Cited by 288 · see citing works
Self-citationStaplin, N., de la Sierra, A., Ruilope, L. M., Emberson, J. R., Vinyoles, E., Gorostidi, M., Ruiz-Hurtado, G., Segura, J., Baigent, C., & Williams, B. (2023) · The Lancet · doi:10.1016/s0140-6736(23)00733-x · Cited by 290 · see citing works
Impact of Obesity on 24-Hour Ambulatory Blood Pressure and Hypertension
Kotsis, V., Stabouli, S., Bouldin, M., Low, A., Toumanidis, S., & Zakopoulos, N. (2005) · Hypertension · doi:10.1161/01.hyp.0000158261.86674.8e · Cited by 262 · see citing works
The differential effects of EPA and DHA on cardiovascular risk factors
Cottin, S. C., Sanders, T. A., & Hall, W. L. (2011) · Proceedings of the Nutrition Society · doi:10.1017/s0029665111000061 · Cited by 247 · see citing works
White, W. B., Weber, M. A., Sica, D., Bakris, G. L., Perez, A., Cao, C., & Kupfer, S. (2011) · Hypertension · doi:10.1161/hypertensionaha.110.163402 · Cited by 216 · see citing works
Iftikhar, I. H., Valentine, C. W., Bittencourt, L. R. A., Cohen, D. L., Fedson, A. C., Gíslason, T., Penzel, T., Phillips, C. L., Yu-sheng, L., Pack, A. I., et al. (2014) · Journal of Hypertension · doi:10.1097/hjh.0000000000000372 · Cited by 215 · see citing works
Clinical Value of Ambulatory Blood Pressure: Evidence and Limits
Mancia, G., & Verdecchia, P. (2015) · Circulation Research · doi:10.1161/circresaha.116.303755 · Cited by 211 · see citing works
Palatini, P., Reboldi, G., Beilin, L. J., Casiglia, E., Eguchi, K., Imai, Y., Kario, K., Ohkubo, T., Pierdomenico, S. D., Schwartz, J. E., et al. (2014) · Hypertension · doi:10.1161/hypertensionaha.114.03694 · Cited by 193 · see citing works
Religious Coping, Ethnicity, and Ambulatory Blood Pressure
Steffen, P. R., Hinderliter, A. L., Blumenthal, J. A., & Sherwood, A. (2001) · Psychosomatic Medicine · doi:10.1097/00006842-200107000-00002 · Cited by 177 · see citing works
Drawz, P. E., Pajewski, N. M., Bates, J. T., Bello, N. A., Cushman, W. C., Dwyer, J. P., Fine, L. J., Goff, D. C., Haley, W. E., Krousel-Wood, M., et al. (2017) · Hypertension · doi:10.1161/hypertensionaha.116.08076 · Cited by 170 · see citing works
Melatonin reduces night blood pressure in patients with nocturnal hypertension
Grossman, E., Laudon, M., Yalcin, R., Zengil, H., Peleg, E., Sharabi, Y., Kamari, Y., Shen-Orr, Z., & Zisapel, N. (2006) · The American Journal of Medicine · doi:10.1016/j.amjmed.2006.02.002 · Cited by 168 · see citing works
Kario, K., Shin, J., Chen, C., Buranakitjaroen, P., Chia, Y., Divinagracia, R., Nailes, J., Hoshide, S., Siddique, S., Sison, J., et al. (2019) · The Journal of Clinical Hypertension · doi:10.1111/jch.13652 · Cited by 164 · see citing works
Hermida, R. C., Ayala, D. E., Fernandez, J. R., Portaluppi, F., Fabbian, F., & Smolensky, M. H. (2011) · American Journal of Hypertension · doi:10.1038/ajh.2010.217 · Cited by 159 · see citing works
Non-dipping pattern of hypertension and obstructive sleep apnea syndrome
Wolf, J., Hering, D., & Narkiewicz, K. (2010) · Hypertension Research · doi:10.1038/hr.2010.153 · Cited by 156 · see citing works
Prevalence of white-coat and masked hypertension in national and international registries
Gorostidi, M., Vinyoles, E., Banegas, J. R., & de la Sierra, A. (2015) · Hypertension Research · doi:10.1038/hr.2014.149 · Cited by 141 · see citing works
Ruschitzka, F., Borer, J. S., Krum, H., Flammer, A. J., Yeomans, N. D., Libby, P., Lüscher, T. F., Solomon, D. H., Husni, M. E., Graham, D. Y., et al. (2017) · European Heart Journal · doi:10.1093/eurheartj/ehx508 · Cited by 130 · see citing works
Nighttime Home Blood Pressure and the Risk of Hypertensive Target Organ Damage
Ishikawa, J., Hoshide, S., Eguchi, K., Ishikawa, S., Shimada, K., Kario, K., & for the Japan Morning Surge-Home Blood Pressure Study Investigators Group (2012) · Hypertension · doi:10.1161/hypertensionaha.112.198101 · Cited by 123 · see citing works
Niiranen, T. J., Asayama, K., Thijs, L., Johansson, J. K., Ohkubo, T., Kikuya, M., Boggia, J., Hozawa, A., Sandoya, E., Stergiou, G. S., et al. (2013) · Hypertension · doi:10.1161/hypertensionaha.111.00100 · Cited by 120 · see citing works
Self-citationWalia, H. K., Li, H., Rueschman, M., Bhatt, D. L., Patel, S. R., Quan, S. F., Gottlieb, D. J., Punjabi, N. M., Redline, S., & Mehra, R. (2014) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.3946 · Cited by 104 · see citing works
Nocturnal nondipping of heart rate predicts cardiovascular events in hypertensive patients
Eguchi, K., Hoshide, S., Ishikawa, J., Pickering, T. G., Schwartz, J. E., Shimada, K., & Kario, K. (2009) · Journal of Hypertension · doi:10.1097/hjh.0b013e328330a938 · Cited by 100 · see citing works
Nocturnal hypertension and impaired sympathovagal tone in Turner syndrome
Gravholt, C. H., Hansen, K. W., Erlandsen, M., Ebbehøj, E., & Christiansen, J. S. (2006) · Journal of Hypertension · doi:10.1097/01.hjh.0000200509.17947.0f · Cited by 90 · see citing works
2020 Consensus summary on the management of hypertension in Asia from the HOPE Asia Network
Kario, K., Park, S., Chia, Y., Sukonthasarn, A., Turana, Y., Shin, J., Chen, C., Buranakitjaroen, P., Divinagracia, R., Nailes, J., et al. (2020) · The Journal of Clinical Hypertension · doi:10.1111/jch.13751 · Cited by 76 · see citing works
Nomura, K., Asayama, K., Thijs, L., Niiranen, T. J., Lujambio, I., Boggia, J., Hozawa, A., Ohkubo, T., Hara, A., Johansson, J. K., et al. (2014) · Hypertension · doi:10.1161/hypertensionaha.114.03839 · Cited by 27 · see citing works
Self-citationHae, H., Kang, S.-J., Kim, T. O., Lee, P. H., Lee, S.-W., Kim, Y.-H., Lee, C. W., & Park, S.-W. (2023) · Blood Pressure · doi:10.1080/08037051.2023.2209674 · Cited by 16 · see citing works
Shen, J., Li, Z.-M., He, L.-Z., Deng, R.-S., Liu, J.-G., & Shen, Y.-S. (2017) · Medicine · doi:10.1097/md.0000000000007807 · Cited by 12 · see citing works
- Authors
- Staessen, J. A.
- Affiliations
- KU Leuven (BE)
- Corresponding author
- Staessen, Jan A.
- ORCID
- Staessen, Jan A.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 1999-08-11
- Volume
- 282
- Issue
- 6
- Pages
- 539
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2103015566
- Cited by
- 1,592
- References
- 0
- Citations by year
- 2026: 11 · 2025: 21 · 2024: 24 · 2023: 25 · 2022: 26 · 2021: 25 · 2020: 38 · 2019: 41 · 2018: 51 · 2017: 53 · 2016: 65 · 2015: 61 · 2014: 68 · 2013: 95 · 2012: 71
- FWCI
- 37.70
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- isolated systolic hypertension, ambulatory blood pressure monitoring, cardiovascular risk prediction, older adults, nocturnal blood pressure dipping, 24-hour ambulatory blood pressure, cardiovascular mortality, stroke, nitrendipine, Syst-Eur trial, antihypertensive therapy
- MeSH terms
- Aged, Antihypertensive Agents, Blood Pressure Determination, Cardiovascular Diseases, Female, Humans, Hypertension, Male, Middle Aged, Prognosis, Risk Factors, Systole, Reproducibility of Results, Randomized Controlled Trials as Topic, Blood Pressure Monitoring, Ambulatory
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
