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RETRACTED: Relationship between Clinic and Ambulatory Blood-Pressure Measurements and Mortality
Open accessAbstract
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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“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]
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“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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Prognostic Value of Ambulatory Blood-Pressure Recordings in Patients with Treated Hypertension
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- Franklin SS, O’Brien E, Staessen JA. Masked hypertension: understanding its complexity. Eur Heart J 2017;38:1112-1118.27836914
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2018 ESC/ESH Guidelines for the management of arterial hypertension
Williams, B., Mancia, G., Spiering, W., Agabiti Rosei, E., Azizi, M., Burnier, M., Clement, D. L., Coca, A., de Simone, G., Dominiczak, A., et al. (2018) · European Heart Journal · doi:10.1093/eurheartj/ehy339 · Cited by 10,286
Self-citationHeart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association
Virani, S. S., Alonso, A., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Chang, A. R., Cheng, S., Delling, F. N., et al. (2020) · Circulation · doi:10.1161/cir.0000000000000757 · Cited by 9,175
Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association
Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Alonso, A., Beaton, A. Z., Bittencourt, M. S., Boehme, A. K., Buxton, A. E., Carson, A. P., Commodore-Mensah, Y., et al. (2022) · Circulation · doi:10.1161/cir.0000000000001052 · Cited by 5,987
Heart Disease and Stroke Statistics—2021 Update: A Report From the American Heart Association
Virani, S. S., Alonso, A., Aparicio, H. J., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Cheng, S., Delling, F. N., et al. (2021) · Circulation · doi:10.1161/cir.0000000000000950 · Cited by 5,784
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Self-citation
Metadata
- 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
- 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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