Predictors of All-Cause Mortality in Clinical Ambulatory Monitoring: Unique Aspects of Blood Pressure During Sleep
Abstract
The prognostic value of sleep blood pressure reported by recent studies is variable. Our aim was to examine the relationship of sleep blood pressure, measured by 24-hour ambulatory blood pressure monitoring, with all-cause mortality. We studied a cohort of 3957 patients aged 55±16 (58% treated) referred for ambulatory monitoring (1991–2005). Sleep, including daytime sleep, was recorded by diary. Linkage with the national population register identified 303 deaths during 27 750 person-years of follow-up. Hazard ratios (HRs) for mortality in Cox proportional hazards models that included age, sex, hypertension, and diabetes treatment were 1.32 (95% CI: 0.99 to 1.76) for awake hypertension (≥135/85 mm Hg), and 1.67 (95% CI: 1.25 to 2.23) for sleep hypertension (≥120/70 mm Hg). By quintile analysis, the upper fifths of systolic and diastolic dipping during sleep were associated with adjusted HRs of 0.58 (95% CI: 0.41 to 0.82) and 0.68 (95% CI: 0.48 to 0.96), respectively. In a model controlling for awake systolic blood pressure, hazards associated with reduced systolic dipping increased from dippers (>10%; HR: 1.0), through nondippers (0% to 9.9%; HR: 1.30; 95% CI: 1.00 to 1.69) to risers (<0%; HR: 1.96; 95% CI: 1.43 to 2.96). Thus, in practice, ambulatory blood pressure predicts mortality significantly better than clinic blood pressure. The availability of blood pressure measures during sleep and, in particular, the pattern of dipping add clinically predictive information and provide further justification for the use of ambulatory monitoring in patient management.
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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 [35]
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- Authors
- Ben-Dov, I. Z., Kark, J. D., Ben-Ishay, D., Mekler, J., Ben-Arie, L., & Bursztyn, M.
- Affiliations
- From the Nephrology and Hypertension (I.Z.B.-D.), Epidemiology Unit (J.D.K.), and Mount-Scopus Internal Medicine Department (D.B.-I., J.M., L.B.-A., M.B.), Hadassah–Hebrew University Medical Center, Jerusalem, Israel.
- Hebrew University of Jerusalem (IL)
- ORCID
- Bursztyn, Michael
- Venue
- Hypertension
- Published
- 2007-06
- Volume
- 49
- Issue
- 6
- Pages
- 1235-1241
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2056904358
- Cited by
- 367
- References
- 2
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 9 · 2023: 14 · 2022: 16 · 2021: 24 · 2020: 16 · 2019: 15 · 2018: 18 · 2017: 15 · 2016: 25 · 2015: 27 · 2014: 18 · 2013: 30 · 2012: 44
- FWCI
- 15.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- 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 › Medicine › Physiology › Obstructive Sleep Apnea Research
- Keywords
- all-cause mortality, ambulatory blood pressure monitoring, sleep blood pressure, nocturnal blood pressure dipping, prognostic factors, cardiovascular risk, older adults
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Blood Pressure, Circadian Rhythm, Female, Heart Rate, Humans, Hypertension, Male, Middle Aged, Predictive Value of Tests, Prognosis, Sleep, Wakefulness, Cohort Studies, Proportional Hazards Models, Blood Pressure Monitoring, Ambulatory
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