Ambulatory BP Is a Better Predictor of Mortality

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Masked hypertension is associated with greater mortality risks than sustained or white coat hypertension, new study finds.
Masked hypertension is associated with greater mortality risks than sustained or white coat hypertension, new study finds.

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.

Reference

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.

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