Ambulatory Blood Pressure and 10-Year Risk of Cardiovascular and Noncardiovascular Mortality: The Ohasama Study
Open accessAbstract
The objective of this study was to elucidate the long-term prognostic significance of ambulatory blood pressure. Ambulatory and casual blood pressure values were obtained from 1332 subjects (872 women and 460 men) aged ≥40 years from the general population of a rural Japanese community. Survival was then followed for 14 370 patient years and analyzed by a Cox hazard model adjusted for possible confounding factors. There were 72 cardiovascular deaths during the 10.8-year follow-up. The relationship between 24-hour systolic blood pressure and the cardiovascular mortality risk was U-shaped in the first 5 years, then changed to J-shaped over the rest of the 10.8-year follow-up. After censoring the first 2 years of data, the risk flattened until it again increased for the fifth quintile of 24-hour systolic blood pressure for the 10.8-year follow-up period. For 24-hour diastolic blood pressure, the J-shaped relationship remained unchanged, regardless of follow-up duration and censoring. Ambulatory systolic blood pressure values consistently showed stronger predictive power for cardiovascular mortality risk than did casual systolic blood pressure in the 10.8-year follow-up data, whereas such relationships became more marked after censoring the first 2 years. When nighttime and daytime systolic blood pressure values were simultaneously included in the same Cox model, only nighttime blood pressure significantly predicted the cardiovascular mortality risk for the 10.8-year follow-up data. We conclude that the relationship between ambulatory systolic blood pressure and cardiovascular mortality is not U-shaped or J-shaped, and that nighttime blood pressure has better prognostic value than daytime blood pressure.
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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 [6]
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- Authors
- Kikuya, M., Ohkubo, T., Asayama, K., Metoki, H., Obara, T., Saito, S., Hashimoto, J., Totsune, K., Hoshi, H., Satoh, H., & Imai, Y.
- Affiliations
- Tohoku University (JP)
- ORCID
- Venue
- Hypertension
- Published
- 2005-02
- Volume
- 45
- Issue
- 2
- Pages
- 240-245
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2098672359
- Cited by
- 417
- References
- 2
- Citations by year
- 2026: 4 · 2025: 11 · 2024: 10 · 2023: 14 · 2022: 7 · 2021: 12 · 2020: 12 · 2019: 18 · 2018: 14 · 2017: 11 · 2016: 25 · 2015: 25 · 2014: 23 · 2013: 23 · 2012: 35
- FWCI
- 19.52
- Type
- journal article
- Language
- en
- Open access
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Institutional Repositories DataBase (IRDB) (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
- ambulatory blood pressure, cardiovascular mortality, non-cardiovascular mortality, 24-hour systolic blood pressure, casual blood pressure, nocturnal blood pressure, daytime blood pressure, J-shaped relationship, U-shaped relationship, prognostic value, long-term survival
- MeSH terms
- Aged, Blood Pressure, Cardiovascular Diseases, Circadian Rhythm, Female, Humans, Longitudinal Studies, Male, Middle Aged, Neoplasms, Prognosis, Prospective Studies, Proportional Hazards Models, Risk Assessment, Blood Pressure Monitoring, Ambulatory
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