Predictive Role of the Nighttime Blood Pressure
Open accessAbstract
Numerous studies addressed the predictive value of the nighttime blood pressure (BP) as captured by ambulatory monitoring. However, arbitrary cutoff limits in dichotomized analyses of continuous variables, data dredging across selected subgroups, extrapolation of cross-sectional studies to prospective outcomes, and lack of comprehensive adjustments for confounders make interpretation of the literature difficult. We reviewed prospective studies with total mortality or a composite cardiovascular end point as an outcome in relation to the level and the circadian profile of systolic BP. We analyzed studies in hypertensive patients (n = 23 856) separately from those in individuals randomly recruited from populations (n = 9641). We pooled summary statistics and individual subject data, respectively. In both patients and populations, in analyses in which nighttime BP was additionally adjusted for daytime BP and vice versa, nighttime BP was a stronger predictor than daytime BP. With adjustment for the 24-hour BP, both the night-to-day BP ratio and dipping status remained significant predictors of outcome but added little prognostic value over and beyond the 24-hour BP level. In the absence of conclusive evidence proving that nondipping is a reversible risk factor, the option whether or not to restore the diurnal blood pressure profile to a normal pattern should be left to the clinical judgment of doctors and should be individualized for each patient. Current guidelines on the interpretation of ambulatory BP recording need to be updated.
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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 [14]
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- Authors
- Hansen, T. W., Li, Y., Boggia, J., Thijs, L., Richart, T., & Staessen, J. A.
- Affiliations
- Shanghai Jiao Tong University (CN)
- From the Research Center for Prevention and Health and Department of Clinical Physiology, Nuclear Medicine and PET (T.W.H.), Rigshospitalet, Copenhagen University Hospital, Faculty of Health Sciences, Rigshospitalet, Copenhagen, Denmark; Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension (Y.L.), Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Departamento de Fisiopatología (J.B.), Hospital...
- Venue
- Hypertension
- Published
- 2011-01
- Volume
- 57
- Issue
- 1
- Pages
- 3-10
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2133295920
- Cited by
- 597
- References
- 5
- Citations by year
- 2026: 28 · 2025: 33 · 2024: 33 · 2023: 45 · 2022: 26 · 2021: 35 · 2020: 41 · 2019: 41 · 2018: 44 · 2017: 41 · 2016: 44 · 2015: 43 · 2014: 42 · 2013: 52 · 2012: 28
- FWCI
- 5.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- Lirias (submittedVersion, other-oa)
- Research Publications (Maastricht University) (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
- nocturnal blood pressure, ambulatory blood pressure monitoring, circadian blood pressure rhythm, dipping, cardiovascular mortality, prognostic value, 24-hour ambulatory blood pressure, personalized treatment
- MeSH terms
- Blood Pressure, Cardiovascular Diseases, Circadian Rhythm, Cross-Sectional Studies, Female, Humans, Hypertension, Male, Prognosis, Risk Factors, Cohort Studies, Blood Pressure Monitoring, Ambulatory
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