Superiority of Ambulatory Over Clinic Blood Pressure Measurement in Predicting Mortality: The Dublin Outcome Study
Open accessAbstract
The purpose of this study was to determine if ambulatory blood pressure measurement predicted total and cardiovascular mortality over and beyond clinic blood pressure measurement and other cardiovascular risk factors; 5292 untreated hypertensive patients referred to a single blood pressure clinic who had clinic and ambulatory blood pressure measurement at baseline were followed up in a prospective study of mortality outcome. Multiple Cox regression was used to model time to total and cause-specific mortality for ambulatory blood pressure measurement while adjusting for clinic blood pressure measurement and other risk factors at baseline. There were 646 deaths (of which 389 were cardiovascular) during a median follow-up period of 8.4 years. With adjustment for gender, age, risk indices, and clinic blood pressure, higher mean values of ambulatory blood pressure were independent predictors for cardiovascular mortality. The relative hazard ratio for each 10-mm Hg increase in systolic blood pressure was 1.12 (1.06 to 1.18; P <0.001) for daytime and 1.21 (1.15 to 1.27; P <0.001) for nighttime systolic blood pressure. The hazard ratios for each 5-mm Hg increase in diastolic blood pressure were 1.02 (0.99 to 1.07; P =NS) for daytime and 1.09 (1.04 to 1.13; P <0.01) for nighttime diastolic pressures. The hazard ratios for nighttime ambulatory blood pressure remained significant after adjustment for daytime ambulatory blood pressure. These results have 2 important clinical messages: ambulatory measurement of blood pressure is superior to clinic measurement in predicting cardiovascular mortality, and nighttime blood pressure is the most potent predictor of outcome.
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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 [11]
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 [11]
High nighttime blood pressure (lack of nocturnal blood pressure dipping) is a sensitive indicator for cardiovascular mortality, with 21% greater risk for each 10-mmHg increase in nighttime systolic blood pressure and 9% greater risk for each 5-mmHg increase in nighttime diastolic blood pressure.
“The morning BP surge is not the only risk, as high nighttime BP (lack of nocturnal BP dipping) is a sensitive indicator for CV mortality, with 21% greater risk for each 10-mmHg increase in nighttime systolic BP and 9% greater risk for each 5-mmHg increase in nighttime diastolic BP (99).”
From Role of the circadian system in cardiovascular disease (2018) · cites this paper as [99]
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- Authors
- Dolan, E., Stanton, A., Thijs, L., Hinedi, K., Atkins, N., McClory, S., Hond, E. D., McCormack, P., Staessen, J. A., & O’Brien, E.
- Affiliations
- Providence St. Vincent Medical Center (US)
- From the ADAPT Centre (E.D., A.S., N.A., S.M., P.M, E.O.) and Blood Pressure Unit, Beaumont Hospital, and Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, Dublin, Ireland; Study Coordinating Centre (L.T., E.D.H., J.A.S.), Laboratory of Hypertension, Hypertension and Cardiovascular Rehabilitation Unit, Department of Molecular and Cardiovascular Research, University of Leuven, Leuven, Belgium; Providence St. Vincent Medical Center (K.H.), Department of Medicine, Portland, Ore.
- Venue
- Hypertension
- Published
- 2005-07
- Volume
- 46
- Issue
- 1
- Pages
- 156-161
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2099301718
- Cited by
- 1,227
- References
- 27
- Citations by year
- 2026: 28 · 2025: 33 · 2024: 42 · 2023: 53 · 2022: 48 · 2021: 50 · 2020: 59 · 2019: 52 · 2018: 67 · 2017: 58 · 2016: 75 · 2015: 92 · 2014: 63 · 2013: 80 · 2012: 81
- FWCI
- 34.72
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Lirias (KU Leuven) (submittedVersion, other-oa)
- 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 monitoring, clinic blood pressure measurement, cardiovascular mortality, all-cause mortality, nocturnal blood pressure, daytime blood pressure, systolic blood pressure, diastolic blood pressure, mortality prediction
- MeSH terms
- Adult, Aged, Blood Pressure, Blood Pressure Determination, Cardiovascular Diseases, Circadian Rhythm, Diastole, Female, Humans, Male, Middle Aged, Office Visits, Predictive Value of Tests, Systole, Proportional Hazards Models, Risk Assessment, Blood Pressure Monitoring, Ambulatory
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