Ambulatory blood pressure (BP) measurements are a stronger predictor of all-cause and cardiovascular mortality than clinic BP measurements, new study findings suggest.
In addition, masked hypertension is associated with a greater mortality risk than sustained and white coat hypertension.
José R. Banegas, MD, of the Universidad Autónoma de Madrid, and colleagues analyzed data from a registry-based, multicenter, national cohort that included 63,910 adults in Spain. They examined clinic and 24-hour ambulatory BP in the following categories: sustained hypertension (elevated clinic and elevated 24-hour ambulatory BP); white coat hypertension (elevated clinic and normal 24-hour ambulatory BP); masked hypertension (normal clinic and elevated 24-hour ambulatory BP); and normotension.
During a median follow-up of 4.7 years, 3808 patients died from any cause, and 1295 of these patients died from cardiovascular causes. In adjusted analyses, each 1 standard deviation (SD) in 24-hour systolic pressure was associated with a 58% increased risk of all-cause and cardiovascular mortality, whereas each 1 SD in clinic systolic pressure was associated with a 2% increased risk of both outcomes, Dr Banegas’ team reported in the New England Journal of Medicine.
Masked hypertension was associated with a significant 2.8-fold increased risk of both all-cause and cardiovascular mortality compared with normotension, whereas sustained hypertension was associated with a significant 80% and 94% increased risk of these outcomes, respectively, and white coat hypertension was associated with a significant 79% and 96% increased risk.
Banegas JR, Ruilope LM, de la Sierra A, et al. Relationship between clinic and ambulatory blood-pressure measurements and mortality. N Engl J Med. 2018;378;1509-1520.