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Previous Volume 348:2407-2415 June 12, 2003 Number 24 Next

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ABSTRACT

Background It is uncertain whether ambulatory blood-pressure measurements recorded for 24 hours in patients with treated hypertension predict cardiovascular events independently of blood-pressure measurements obtained in the physician's office and other cardiovascular risk factors.

Methods We assessed the association between base-line ambulatory blood pressures in treated patients and subsequent cardiovascular events among 1963 patients with a median follow-up of 5 years (range, 1 to 66 months).

Results We documented new cardiovascular events in 157 patients. In a Cox proportional-hazards model with adjustment for age, sex, smoking status, presence or absence of diabetes mellitus, serum cholesterol concentration, body-mass index, use or nonuse of lipid-lowering drugs, and presence or absence of a history of cardiovascular events, as well as blood pressure measured at the physician's office, higher mean values for 24-hour ambulatory systolic and diastolic blood pressure were independent risk factors for new cardiovascular events. The adjusted relative risk of cardiovascular events associated with a 1-SD increment in blood pressure was 1.34 (95 percent confidence interval, 1.11 to 1.62) for 24-hour ambulatory systolic blood pressure, 1.30 (95 percent confidence interval, 1.08 to 1.58) for ambulatory systolic blood pressure during the daytime, and 1.27 (95 percent confidence interval, 1.07 to 1.57) for ambulatory systolic blood pressure during the nighttime. For ambulatory diastolic blood pressure, the corresponding relative risks of cardiovascular events associated with a 1-SD increment were 1.21 (95 percent confidence interval, 1.01 to 1.46), 1.24 (95 percent confidence interval, 1.03 to 1.49), and 1.18 (95 percent confidence interval, 0.98 to 1.40).

Conclusions In patients with treated hypertension, a higher ambulatory systolic or diastolic blood pressure predicts cardiovascular events even after adjustment for classic risk factors including office measurements of blood pressure.

Source Information

From the Departments of Cardiovascular Diseases (D.L.C., M.L.D.B., D.A.D., P.J.G.) and Public Health (D.A.D.B.), Ghent University, Ghent, Belgium; the Department of Medicine, University Hospital Maastricht, Maastricht, the Netherlands (P.W.L.); the Cardiovascular Division, University of Minnesota, Minneapolis (D.A.D.); the Hypertension and Cardiovascular Rehabilitation Unit, University of Leuven, Leuven, Belgium (R.H.F.); the Department of Cardiology, Algemeen Ziekenhuis St. Jan, Bruges, Belgium (L.H.M.); the Department of Internal Medicine, Vlietland Hospital, Schiedam, the Netherlands (J.J.B.); the Department of Internal Medicine and Hypertension, Vrije Universiteit Brussel, Brussels, Belgium (R.O.S., P.V.D.N.); and the Blood Pressure Unit and Arterial Disease, Assessment, Prevention, and Treatment Centre, Beaumont Hospital, Dublin, Ireland (E.O.).

Address reprint requests to Dr. Clement at the Department of Cardiology and Angiology, University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium, or at denis.clement{at}skynet.be.

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