RETRACTED: Relationship between Clinic and Ambulatory Blood-Pressure Measurements and Mortality
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BACKGROUND: Evidence for the influence of ambulatory blood pressure on prognosis derives mainly from population-based studies and a few relatively small clinical investigations. This study examined the associations of blood pressure measured in the clinic (clinic blood pressure) and 24-hour ambulatory blood pressure with all-cause and cardiovascular mortality in a large cohort of patients in primary care. METHODS: We analyzed data from a registry-based, multicenter, national cohort that included 63,910 adults recruited from 2004 through 2014 in Spain. Clinic and 24-hour ambulatory blood-pressure data were examined in the following categories: sustained hypertension (elevated clinic and elevated 24-hour ambulatory blood pressure), "white-coat" hypertension (elevated clinic and normal 24-hour ambulatory blood pressure), masked hypertension (normal clinic and elevated 24-hour ambulatory blood pressure), and normotension (normal clinic and normal 24-hour ambulatory blood pressure). Analyses were conducted with Cox regression models, adjusted for clinic and 24-hour ambulatory blood pressures and for confounders. RESULTS: During a median follow-up of 4.7 years, 3808 patients died from any cause, and 1295 of these patients died from cardiovascular causes. In a model that included both 24-hour and clinic measurements, 24-hour systolic pressure was more strongly associated with all-cause mortality (hazard ratio, 1.58 per 1-SD increase in pressure; 95% confidence interval [CI], 1.56 to 1.60, after adjustment for clinic blood pressure) than the clinic systolic pressure (hazard ratio, 1.02; 95% CI, 1.00 to 1.04, after adjustment for 24-hour blood pressure). Corresponding hazard ratios per 1-SD increase in pressure were 1.55 (95% CI, 1.53 to 1.57, after adjustment for clinic and daytime blood pressures) for nighttime ambulatory systolic pressure and 1.54 (95% CI, 1.52 to 1.56, after adjustment for clinic and nighttime blood pressures) for daytime ambulatory systolic pressure. These relationships were consistent across subgroups of age, sex, and status with respect to obesity, diabetes, cardiovascular disease, and antihypertensive treatment. Masked hypertension was more strongly associated with all-cause mortality (hazard ratio, 2.83; 95% CI, 2.12 to 3.79) than sustained hypertension (hazard ratio, 1.80; 95% CI, 1.41 to 2.31) or white-coat hypertension (hazard ratio, 1.79; 95% CI, 1.38 to 2.32). Results for cardiovascular mortality were similar to those for all-cause mortality. CONCLUSIONS: Ambulatory blood-pressure measurements were a stronger predictor of all-cause and cardiovascular mortality than clinic blood-pressure measurements. White-coat hypertension was not benign, and masked hypertension was associated with a greater risk of death than sustained hypertension. (Funded by the Spanish Society of Hypertension and others.).
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Office BP is consistently least predictive of cardiovascular outcomes among BP measurement methods due to white-coat and masked effects.
“Although office BP was the most commonly used method by the included RCTs and in clinical practice, it is consistently least predictive of cardiovascular outcomes among BP measurement methods due to both white-coat and masked effects 51,52”
From Effect and Acceptability of Mindfulness-Based Stress Reduction Program on Patients With Elevated Blood Pressure or Hypertension: A Meta-Analysis of Randomized Controlled Trials (2020) · cites this paper as [52]
The Discussion (p. 1519) says that 24-hour, daytime, and nighttime ambulatory systolic pressures predicted cardiovascular mortality better than clinic pressure. The paper also examines white-coat and masked hypertension, but it does not establish that those effects cause the difference in predictive performance or show that office BP is least predictive among all measurement methods. (LLM, conf=0.87)
Experimental — accuracy not yet measuredLack of nocturnal decline in blood pressure (nondipping) carries a significant risk of cardiovascular morbidity and mortality that largely exceeds that of office-based hypertension.
“Lack of nocturnal decline in blood pressure, in the form of nocturnal hypertension or ‘nondipping’, carries a significant risk of cardiovascular morbidity and mortality which largely exceeds that of office‐based hypertension 30, 63.”
From The Circadian Syndrome: is the Metabolic Syndrome and much more! (2019) · cites this paper as [63]
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Advances in Non-Invasive Blood Pressure Monitoring
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Long Working Hours and the Prevalence of Masked and Sustained Hypertension
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Hypertension: Current trends and future perspectives
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Implementing Home Blood Pressure Monitoring into Clinical Practice
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Blood pressure monitoring in sleep: time to wake up
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Regression to the mean of repeated ambulatory blood pressure monitoring in five studies
Moore, M. N., Atkins, E., Salam, A., Callisaya, M. L., Hare, J., Marwick, T. H., Nelson, M. R., Wright, L. M., Sharman, J. E., & Rodgers, A. (2018) · Journal of Hypertension · doi:10.1097/hjh.0000000000001977 · Cited by 51 · see citing works
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Effect of a Walnut Diet on Office and 24-Hour Ambulatory Blood Pressure in Elderly Individuals
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Association of Fatal and Nonfatal Cardiovascular Outcomes With 24-Hour Mean Arterial Pressure
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2019 AHA/ACC Clinical Performance and Quality Measures for Adults With High Blood Pressure
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White Coat Hypertension in Children and Adolescents.
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2018 ESC/ESH Guidelines for the management of arterial hypertension
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Variations in 24-Hour BP Profiles in Cohorts of Patients with Kidney Disease around the World
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Gijón‐Conde, T., Sánchez-Martínez, M., Graciani, A., de la Cruz, J. J., López‐García, E., Ortolá, R., Rodríguez‐Artalejo, F., & Banegas, J. R. (2019) · Journal of Hypertension · doi:10.1097/hjh.0000000000002065 · Cited by 43 · see citing works
Self-citationMasked hypertension incidence and risk factors in a prospective cohort study
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Baseline hs‐CRP predicts hypertension remission in metabolic syndrome
Carbone, F., Elia, E., Casula, M., Bonaventura, A., Liberale, L., Bertolotto, M. B., Artom, N., Minetti, S., Dallegri, F., Contini, P., et al. (2019) · European Journal of Clinical Investigation · doi:10.1111/eci.13128 · Cited by 43 · see citing works
Gijón‐Conde, T., Gorostidi, M., Banegas, J. R., de la Sierra, A., Segura, J., Vinyoles, E., Divisón, J. A., & Ruilope, L. M. (2019) · Hipertensión y Riesgo Vascular · doi:10.1016/j.hipert.2019.05.002 · Cited by 41 · see citing works
Self-citationLong-term effects of baroreflex activation therapy: 2-year follow-up data of the BAT Neo system
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Feitosa, A. D. M., Gomes, M. A. M., Barroso, W. K. S., Miranda, R. D., Barbosa, E. C. D., Pedrosa, R. P., Oliveira, P. C., Feltosa, C. L. D. M., Brandão, A. A., de Lima-Filho, J. L., et al. (2019) · Journal of Hypertension · doi:10.1097/hjh.0000000000002320 · Cited by 41 · see citing works
Management of traditional risk factors for the development and progression of chronic kidney disease
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Blood Pressure Pattern and Target Organ Damage in Patients With Chronic Kidney Disease
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Reprint of: Prevention and Control of Hypertension
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Blood Pressure Measurement: A KDOQI Perspective
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- Authors
- 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.
- Affiliations
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES)
- Research Institute Hospital 12 de Octubre (ES)
- Department of Internal Medicine. Hospital Mutua Terrassa. University of Barcelona, Barcelona, Spain
- Universitat de Barcelona (ES)
- Hospital Universitario Central de Asturias (ES)
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid ⁄IdiPAZ and CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Hypertension Unit and Cardiorenal Translational Research Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre and CIBER of Cardiovascular Disease (CIBERCV), Madrid, Spain
- National Institute for Health and Care Research (GB)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2018-04-19
- Volume
- 378
- Issue
- 16
- Pages
- 1509-1520
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2802565200
- Cited by
- 490
- References
- 37
- Citations by year
- 2026: 11 · 2025: 14 · 2024: 23 · 2023: 30 · 2022: 52 · 2021: 42 · 2020: 66 · 2019: 182 · 2018: 67 · 2017: 2
- FWCI
- 67.43
- Type
- journal article
- Language
- en
- Status
- Retracted
- Update notices
- retraction (2020-01-29)
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (publishedVersion)
- ABACUS. Repositorio de Producción Científica (Universidad Europea) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- RECERCAT (Consorci de Serveis Universitaris de Catalunya) (submittedVersion, public-domain)
- Funders
- FIS (PI16/01460)
- Spanish Society of Hypertension (Cardiorisc 1)
- Lacer Laboratories (Cardiorisc Mapapres 1)
- 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
- ambulatory blood pressure, office blood pressure, white coat hypertension, masked hypertension, sustained hypertension, all-cause mortality, cardiovascular mortality, nocturnal blood pressure, daytime blood pressure, systolic blood pressure, primary care patients, hypertension prognosis, retraction, antihypertensive therapy, obesity, diabetes mellitus, cardiovascular disease
- MeSH terms
- Aged, Blood Pressure, Blood Pressure Determination, Cardiovascular Diseases, Cause of Death, Female, Humans, Hypertension, Male, Middle Aged, Prognosis, Risk Factors, Spain, Cohort Studies, Blood Pressure Monitoring, Ambulatory, White Coat Hypertension, Masked Hypertension
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