#VisualAbstract: Association of Office and Ambulatory Blood Pressure With Mortality and Cardiovascular Outcomes

1. In this prospective cohort study, higher 24-hour and nighttime blood pressure measurements were significantly associated with greater risks of death and a composite cardiovascular (CV) outcome.

2. 24-hour and nighttime blood pressure may be considered optimal measurements for estimating CV risk however, there was only a very modest improvement in prediction of risk when added to standard blood pressure indexes taken in ambulatory settings.

Evidence Rating Level: 2 (Good)

Study Rundown: Ambulatory blood pressure (BP) readings are recommended by most national guidelines for hypertension assessments. However, recent studies suggest that nighttime measurements may be more predictive of poor outcomes in hypertension, and it is unclear if BP readings at night or over 24 hours are similar in terms of assessing risk. In this prospective cohort study, higher 24-hour and nighttime blood pressure measurements were significantly associated with greater risks of death and a composite cardiovascular (CV) outcome, even after adjusting for other office-based or ambulatory blood pressure measurements. 24-hour and nighttime blood pressure were found to be optimal measurements for estimating CV risk, however, there was only a very modest improvement in prediction of risk when added to standard blood pressure indexes.

Though this study suggests small improvements in hypertension risk assessment with nighttime and 24-hour BP index, it has some limitations. Antihypertensive drug treatment was only recorded at baseline and could therefore not be adjusted for as a time-dependent covariable. There also might be misclassification bias in the assessment of the CV study end points.

Click to read the study in JAMA

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