Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study
Open accessAbstract
Background Few studies have formally compared the predictive value of the blood pressure at night over and beyond the daytime value. We investigated the prognostic significance of the ambulatory blood pressure during night and day and of the night-to-day blood pressure ratio. Methods We did 24-h blood pressure monitoring in 7458 people (mean age 56.8 years [SD 13.9]) enrolled in prospective population studies in Denmark, Belgium, Japan, Sweden, Uruguay, and China. We calculated multivariate-adjusted hazard ratios for daytime and night-time blood pressure and the systolic night-to-day ratio, while adjusting for cohort and cardiovascular risk factors. Findings Median follow-up was 9.6 years (5th to 95th percentile 2.5-13.7). Adjusted for daytime blood pressure, night-time blood pressure predicted total (n=983; p<0.0001), cardiovascular (n=387; p<0.01), and non-cardiovascular (n=560; p<0.001) mortality. Conversely, adjusted for night-time blood pressure, daytime blood pressure predicted only non-cardiovascular mortality (p<0.05), with lower blood pressure levels being associated with increased risk. Both daytime and night-time blood pressure consistently predicted all cardiovascular events (n=943; p<0.05) and stroke (n=420; p<0.01). Adjusted for night-time blood pressure, daytime blood pressure lost prognostic significance only for cardiac events (n=525; p> or =0.07). Adjusted for the 24-h blood pressure, night-to-day ratio predicted mortality, but not fatal combined with non-fatal events. Antihypertensive drug treatment removed the significant association between cardiovascular events and the daytime blood pressure. Participants with systolic night-to-day ratio value of 1 or more were older, at higher risk of death, and died at an older age than those whose night-to-day ratio was normal (> or =0.80 to <0.90). Interpretation In contrast to commonly held views, daytime blood pressure adjusted for night-time blood pressure predicts fatal combined with non-fatal cardiovascular events, except in treated patients, in whom antihypertensive drugs might reduce blood pressure during the day, but not at night. The increased mortality in patients with higher night-time than daytime blood pressure probably indicates reverse causality. Our findings support recording the ambulatory blood pressure during the whole day.
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?
Both manual auscultatory and automated oscillometric OBP measurements predict stroke or systemic embolism in atrial fibrillation patients.
“a recent meta-analysis, which showed that both manual auscultatory and automated oscillometric OBP measurements predict stroke or systemic embolism in atrial fibrillation patients, and follow-up BP control has superior predictive ability than baseline BP [217].”
Follow-up BP control has superior predictive ability than baseline BP in atrial fibrillation patients.
“a recent meta-analysis, which showed that both manual auscultatory and automated oscillometric OBP measurements predict stroke or systemic embolism in atrial fibrillation patients, and follow-up BP control has superior predictive ability than baseline BP [217].”
Cites
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
Mancia, G., Facchetti, R., Bombelli, M., Grassi, G., & Sega, R. (2006) · Hypertension · doi:10.1161/01.hyp.0000215363.69793.bb · Cited by 691 · see citing works
Diagnostic Thresholds for Ambulatory Blood Pressure Monitoring Based on 10-Year Cardiovascular Risk
Kikuya, M., Hansen, T. W., Thijs, L., Björklund-Bodegård, K., Kuznetsova, T., Ohkubo, T., Richart, T., Torp-Pedersen, C., Lind, L., Ibsen, H., et al. (2007) · Circulation · doi:10.1161/circulationaha.106.662254 · Cited by 314 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Measurement of Blood Pressure in Humans: A Scientific Statement From the American Heart Association
Muntner, P., Shimbo, D., Carey, R. M., Charleston, J. B., Gaillard, T., Misra, S., Myers, M. G., Ogedegbe, G., Schwartz, J. E., Townsend, R. R., et al. (2019) · Hypertension · doi:10.1161/hyp.0000000000000087 · Cited by 1,512 · see citing works
European 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-citationJellinger, P. S., Handelsman, Y., Rosenblit, P. D., Bloomgarden, Z. T., Fonseca, V. A., Garber, A. J., Grunberger, G., Guerin, C. K., Bell, D. S. H., Mechanick, J. I., et al. (2017) · Endocrine Practice · doi:10.4158/ep171764.appgl · Cited by 1,094 · see citing works
Assessment 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
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
Circadian rhythms and the molecular clock in cardiovascular biology and disease
Crnko, S., Du Pré, B. C., Sluijter, J. P. G., & Van Laake, L. W. (2019) · Nature Reviews Cardiology · doi:10.1038/s41569-019-0167-4 · Cited by 499 · 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
RetractedHansen, T. W., Thijs, L., Li, Y., Boggia, J., Kikuya, M., Björklund-Bodegård, K., Richart, T., Ohkubo, T., Jeppesen, J., Torp-Pedersen, C., et al. (2010) · Hypertension · doi:10.1161/hypertensionaha.109.140798 · Cited by 480 · see citing works
Self-citationCircadian disruption and human health
Fishbein, A. B., Knutson, K. L., & Zee, P. C. (2021) · Journal of Clinical Investigation · doi:10.1172/jci148286 · Cited by 468 · 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
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-citationNocturnal Hypertension: New Technology and Evidence
Kario, K. (2018) · Hypertension · doi:10.1161/hypertensionaha.118.10971 · Cited by 298 · see citing works
Prognostic 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
Staplin, 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
Kario, K., Okada, K., Kato, M., Nishizawa, M., Yoshida, T., Asano, T., Uchiyama, K., Niijima, Y., Katsuya, T., Urata, H., et al. (2019) · Circulation · doi:10.1161/circulationaha.118.037076 · Cited by 251 · see citing works
Nocturnal blood pressure and cardiovascular disease: a review of recent advances
Yano, Y., & Kario, K. (2012) · Hypertension Research · doi:10.1038/hr.2012.26 · Cited by 227 · see citing works
Hermida, R. C., Ayala, D. E., Mojón, A., & Fernández, J. R. (2011) · Diabetes Care · doi:10.2337/dc11-0297 · Cited by 213 · 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
Hermida, R. C., Ayala, D. E., Mojón, A., & Fernández, J. R. (2013) · Chronobiology International · doi:10.3109/07420528.2012.701127 · Cited by 203 · see citing works
Lanfranchi, P. A., Pennestri, M.-H., Fradette, L., Dumont, M., Morin, C. M., & Montplaisir, J. (2009) · Sleep · doi:10.1093/sleep/32.6.760 · Cited by 198 · see citing works
Obstructive sleep apnea syndrome and hypertension: ambulatory blood pressure
Kario, K. (2009) · Hypertension Research · doi:10.1038/hr.2009.56 · Cited by 185 · see citing works
Parati, G., Stergiou, G. S., Bilo, G., Kollias, A., Pengo, M., Ochoa, J. E., Agarwal, R., Asayama, K., Asmar, R., Burnier, M., et al. (2021) · Journal of Hypertension · doi:10.1097/hjh.0000000000002922 · Cited by 178 · see citing works
Self-citationRelationship between OSA and hypertension
Torres, G., Sánchez-de-la-Torre, M., & Barbé, F. (2015) · CHEST · doi:10.1378/chest.15-0136 · Cited by 174 · see citing works
Kario, K., Kanegae, H., Tomitani, N., Okawara, Y., Fujiwara, T., Yano, Y., Hoshide, S., & on behalf of the J-HOP Study Group (2019) · Hypertension · doi:10.1161/hypertensionaha.118.12740 · Cited by 167 · 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
Self-citationHermida, 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
Prognostic Value of Nocturnal Blood Pressure Reduction in Resistant Hypertension
Muxfeldt, E. S., Cardoso, C. R. L., & Salles, G. F. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.68 · Cited by 155 · 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
Nocturnal blood pressure measured by home devices: evidence and perspective for clinical application
Asayama, K., Fujiwara, T., Hoshide, S., Ohkubo, T., Kario, K., Stergiou, G. S., Parati, G., White, W. B., Weber, M. A., & Imai, Y. (2019) · Journal of Hypertension · doi:10.1097/hjh.0000000000001987 · Cited by 120 · see citing works
Self-citationHoshide, S., Kario, K., de la Sierra, A., Bilo, G., Schillaci, G., Banegas, J. R., Gorostidi, M., Segura, J., Lombardi, C., Omboni, S., et al. (2015) · Hypertension · doi:10.1161/hypertensionaha.115.05958 · Cited by 117 · see citing works
Ayala, D. E., Hermida, R. C., Mojón, A., & Fernández, J. R. (2013) · Chronobiology International · doi:10.3109/07420528.2012.701455 · Cited by 87 · see citing works
Quinaglia, T., Martins, L. C., Figueiredo, V. N., Santos, R. C., Yugar-Toledo, J. C., Martin, J. F. V., Demacq, C., Pimenta, E., Calhoun, D. A., & Moreno, H. (2011) · Journal of Human Hypertension · doi:10.1038/jhh.2011.43 · Cited by 57 · see citing works
Dhaun, N., Moorhouse, R., MacIntyre, I. M., Melville, V., Oosthuyzen, W., Kimmitt, R. A., Brown, K. E., Kennedy, E. D., Goddard, J., & Webb, D. J. (2014) · Hypertension · doi:10.1161/hypertensionaha.114.03533 · Cited by 54 · see citing works
Mokwatsi, G. G., Hoshide, S., Kanegae, H., Fujiwara, T., Negishi, K., Schutte, A. E., & Kario, K. (2020) · Hypertension · doi:10.1161/hypertensionaha.119.14344 · Cited by 53 · see citing works
Crinion, S. J., Ryan, S., & McNicholas, W. T. (2017) · European Respiratory Journal · doi:10.1183/13993003.01818-2016 · Cited by 50 · see citing works
Orthostatic hypotension is associated with nocturnal change in systolic blood pressure
Voichanski, S., Grossman, C., Leibowitz, A., Peleg, E., Koren-Morag, N., Sharabi, Y., Shamiss, A., & Grossman, E. (2012) · American Journal of Hypertension · doi:10.1038/ajh.2011.191 · Cited by 49 · see citing works
Hermida, R. C., Ríos, M. T., Crespo, J. J., Moyá, A., Domínguez-Sardiña, M., Otero, A., Sánchez, J. J., Mojón, A., Fernández, J. R., Ayala, D. E., et al. (2013) · Chronobiology International · doi:10.3109/07420528.2012.701460 · Cited by 48 · see citing works
Role of ambulatory and home blood pressure recording in clinical practice.
Ghuman, N., Campbell, P., & White, W. B. (2009) · Current Cardiology Reports · doi:10.1007/s11886-009-0060-6 · Cited by 44 · see citing works
Obesity, sleep apnea, aldosterone, and hypertension
Goodfriend, T. L. (2008) · Current Hypertension Reports · doi:10.1007/s11906-008-0042-x · Cited by 44 · see citing works
Diagnosis and management of resistant hypertension: state of the art
Wei, F.-F., Zhang, Z.-Y., Huang, Q.-F., & Staessen, J. A. (2018) · Nature Reviews Nephrology · doi:10.1038/s41581-018-0006-6 · Cited by 39 · see citing works
Self-citationNomura, 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-citationManagement of Hypertension in Diabetic Patients With Chronic Kidney Disease
Steigerwalt, S. (2008) · Diabetes Spectrum · doi:10.2337/diaspect.21.1.30 · Cited by 19 · see citing works
The effect of treatment for sleep apnoea on determinants of blood pressure control
Casitas, R., Martínez-Cerón, E., Galera, R., Cubillos-Zapata, C., González-Villalba, M. J., Fernández-Navarro, I., Sánchez, B., García-Sánchez, A., Zamarrón, E., & García-Río, F. (2017) · European Respiratory Journal · doi:10.1183/13993003.01261-2017 · Cited by 17 · see citing works
- Authors
- Boggia, J., Li, Y., Thijs, L., Hansen, T. W., Kikuya, M., Björklund-Bodegård, K., Richart, T., Ohkubo, T., Kuznetsova, T., Torp-Pedersen, C., Lind, L., Ibsen, H., Imai, Y., Wang, J., Sandoya, E., O'Brien, E., & Staessen, J. A.
- Affiliations
- Shanghai Jiao Tong University (CN)
- KU Leuven (BE)
- Copenhagen University Hospital (DK)
- Tohoku University (JP)
- Uppsala University (SE)
- University College Dublin (IE)
- Corresponding author
- Staessen, Jan A
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2007-10
- Volume
- 370
- Issue
- 9594
- Pages
- 1219-1229
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2160368930
- Cited by
- 887
- References
- 3
- Citations by year
- 2026: 32 · 2025: 38 · 2024: 45 · 2023: 37 · 2022: 40 · 2021: 49 · 2020: 52 · 2019: 53 · 2018: 54 · 2017: 50 · 2016: 56 · 2015: 61 · 2014: 42 · 2013: 58 · 2012: 59
- FWCI
- 28.65
- Type
- journal article
- Language
- en
- Open access
- green
- lirias.kuleuven.be
- Licence
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Lirias (KU Leuven) (submittedVersion, other-oa)
- Institutional Repositories DataBase (IRDB) (submittedVersion, cc-by-nc-nd)
- Funders
- Hjerteforeningen (01-2-9-9A-22914)
- European Commission (LSHM-CT-2006-037093, IC15-CT98-0329-EPOGH)
- National Natural Science Foundation of China (30571607)
- KU Leuven
- Vlaamse regering
- H. Lundbeck A/S
- 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
- daytime blood pressure, prognostic value, cardiovascular mortality, stroke, antihypertensive therapy, reverse causality, 24-hour ambulatory blood pressure monitoring, cardiovascular events, hypertension, cardiovascular risk factors, age at death, cardiovascular risk stratification, cardiovascular screening
- MeSH terms
- Aged, Blood Pressure, Cardiovascular Diseases, Circadian Rhythm, Female, Humans, Male, Middle Aged, Prognosis, Risk Factors, Cohort Studies, Survival Analysis, 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
