Daytime and Nighttime Blood Pressure as Predictors of Death and Cause-Specific Cardiovascular Events in Hypertension
Open accessAbstract
Our aim was to assess the prognostic significance of nighttime and daytime ambulatory blood pressure and their ratio for mortality and cause-specific cardiovascular events in hypertensive patients without major cardiovascular disease at baseline. We performed a meta-analysis on individual data of 3468 patients from 4 prospective studies performed in Europe. Age of the subjects averaged 61±13 years, 45% were men, 13.7% smoked, 8.4% had diabetes, and 61% were under antihypertensive treatment at the time of ambulatory blood pressure monitoring. Office, daytime, and nighttime blood pressure averaged 159±20/91±12, 143±17/87±12, and 130±18/75±12 mm Hg. Total follow-up amounted to 23 164 patient-years. We used multivariable Cox regression analysis to assess the hazard ratios associated with 1 standard deviation higher blood pressure. Daytime and nighttime systolic blood pressure predicted all-cause and cardiovascular mortality, coronary heart disease, and stroke, independently from office blood pressure and confounding variables. When these blood pressures were entered simultaneously into the models, nighttime blood pressure predicted all outcomes, whereas daytime blood pressure did not add prognostic precision to nighttime pressure. Appropriate interaction terms indicated that the results were similar in men and women, in younger and older patients, and in treated and untreated patients The systolic night–day blood pressure ratio predicted all outcomes, which only persisted for all-cause mortality after adjustment for 24-hour blood pressure. In conclusion, nighttime blood pressure is in general a better predictor of outcome than daytime pressure in hypertensive patients, and the night–day blood pressure ratio predicts mortality, even after adjustment for 24-hour blood pressure.
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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 [13]
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- Authors
- Fagard, R. H., Celis, H., Thijs, L., Staessen, J. A., Clement, D. L., De Buyzere, M. L., & De Bacquer, D. A.
- Affiliations
- Ghent University (BE)
- From the Hypertension and Cardiovascular Rehabilitation Unit (R.H.F., H.C., L.T., J.A.S.), Faculty of Medicine, University of Leuven; the Department of Cardiovascular Diseases (D.L.C., M.L.D.B.), Ghent University; and the Department of Public Health (D.A.D.B.), Ghent University, Belgium.
- Venue
- Hypertension
- Published
- 2008-01
- Volume
- 51
- Issue
- 1
- Pages
- 55-61
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2102794110
- Cited by
- 742
- References
- 1
- Citations by year
- 2026: 17 · 2025: 29 · 2024: 26 · 2023: 32 · 2022: 40 · 2021: 44 · 2020: 51 · 2019: 46 · 2018: 36 · 2017: 43 · 2016: 59 · 2015: 51 · 2014: 37 · 2013: 65 · 2012: 52
- FWCI
- 16.67
- Type
- journal article
- Language
- en
- Open access
- green
- lirias.kuleuven.be
- Licence
- other-oa
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Lirias (submittedVersion, other-oa)
- Ghent University Academic Bibliography (Ghent University) (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, nocturnal blood pressure, daytime blood pressure, cardiovascular mortality, all-cause mortality, coronary artery disease, stroke, prognostic factors, untreated hypertension
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Belgium, Blood Pressure, Cardiovascular Diseases, Circadian Rhythm, Europe, Female, Follow-Up Studies, Humans, Hypertension, Male, Middle Aged, Predictive Value of Tests, Prognosis, Prospective Studies, Odds Ratio, Blood Pressure Monitoring, Ambulatory
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