Document Detail


Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study.
MedLine Citation:
PMID:  15939805     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The purpose of this study was to determine if ambulatory blood pressure measurement predicted total and cardiovascular mortality over and beyond clinic blood pressure measurement and other cardiovascular risk factors; 5292 untreated hypertensive patients referred to a single blood pressure clinic who had clinic and ambulatory blood pressure measurement at baseline were followed up in a prospective study of mortality outcome. Multiple Cox regression was used to model time to total and cause-specific mortality for ambulatory blood pressure measurement while adjusting for clinic blood pressure measurement and other risk factors at baseline. There were 646 deaths (of which 389 were cardiovascular) during a median follow-up period of 8.4 years. With adjustment for gender, age, risk indices, and clinic blood pressure, higher mean values of ambulatory blood pressure were independent predictors for cardiovascular mortality. The relative hazard ratio for each 10-mm Hg increase in systolic blood pressure was 1.12 (1.06 to 1.18; P<0.001) for daytime and 1.21 (1.15 to 1.27; P<0.001) for nighttime systolic blood pressure. The hazard ratios for each 5-mm Hg increase in diastolic blood pressure were 1.02 (0.99 to 1.07; P=NS) for daytime and 1.09 (1.04 to 1.13; P<0.01) for nighttime diastolic pressures. The hazard ratios for nighttime ambulatory blood pressure remained significant after adjustment for daytime ambulatory blood pressure. These results have 2 important clinical messages: ambulatory measurement of blood pressure is superior to clinic measurement in predicting cardiovascular mortality, and nighttime blood pressure is the most potent predictor of outcome.
Authors:
Eamon Dolan; Alice Stanton; Lut Thijs; Kareem Hinedi; Neil Atkins; Sean McClory; Elly Den Hond; Patricia McCormack; Jan A Staessen; Eoin O'Brien
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2005-06-06
Journal Detail:
Title:  Hypertension     Volume:  46     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-06-24     Completed Date:  2005-11-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  156-61     Citation Subset:  IM    
Affiliation:
ADAPT Centre, Beaumont Hospital, Department of Clinical Pharmacology, Royal College of Surgeons, Dublin, Ireland.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Blood Pressure
Blood Pressure Determination / methods*,  standards
Blood Pressure Monitoring, Ambulatory* / standards
Cardiovascular Diseases / mortality*
Circadian Rhythm
Diastole
Female
Humans
Male
Middle Aged
Office Visits*
Predictive Value of Tests
Proportional Hazards Models
Risk Assessment
Systole
Comments/Corrections
Comment In:
Hypertension. 2005 Oct;46(4):e11; author reply e11-2   [PMID:  16172433 ]
Hypertension. 2005 Jul;46(1):25-6   [PMID:  15928027 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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