Relationship between clinic and ambulatory blood pressure and mortality: an observational cohort study in 59 124 patients

Staplin, Natalie; Sierra, Alejandro de la; Ruilope, Luis; Emberson, Jonathan; Vinyoles, Ernest; Gorostidi, Manuel; Ruiz‐Hurtado, Gema; Segura, J.; Baigent, Colin; Williams, Bryan

doi:10.1016/s0140-6736(23)00733-x

Cited by 102 publications

(49 citation statements)

References 39 publications

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“…The prognostic importance of night-time BP with respect to mortality [3,4] and the fact that the normal circadian rhythm is associated with BP reduction during sleep, that is, the dipping pattern [19,20], has stimulated the search for therapeutic strategies to reduce nocturnal BP. This led to the hypothesis that using evening or bedtime dosing of antihypertensive drugs would more effectively reduce night-time BP and restore or enhance the nocturnal BP dip.…”

Section: Discussionmentioning

confidence: 99%

“…The Spanish ABPM Registry was developed to promote the use of ABPM in clinical practice. Details about recruitment characteristics have been previously reported [3,12,13]. Patients were required to be aged at least 18 years and to meet guideline-recommended indications for ABPM, which included suspected white-coat hypertension, refractory or resistant hypertension, assessment of drug treatment efficacy, high-risk hypertension, labile or borderline hypertension, and the study of circadian BP pattern.…”

Section: Methodsmentioning

confidence: 99%

“…Ambulatory blood pressure (BP) monitoring (ABPM) is widely recommended in hypertension guidelines [1,2]. BP indices obtained through this measurement technique better predict mortality than clinic or office BP [3]. Among different ABPM estimates, night-time SBP appears to be the most powerful predictor of both mortality and cardiovascular events [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…The Spanish ABPM registry has records of medication and blood pressure status of thousands of patients, with linked mortality, data extending to a mean follow-up of almost 10 years [3]. We now report how we used this registry to evaluate the risk of all-cause and cardiovascular mortality in treated hypertensive patients, according to the patient-reported schedule of timing of antihypertensive treatment administration (in the morning, or in the evening), collected at the time ABPM was performed.…”

Section: Introductionmentioning

confidence: 99%

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Impact of timing of antihypertensive treatment on mortality: an observational study from the Spanish Ambulatory Blood Pressure Monitoring Registry

de la Sierra,

Ruilope,

Martínez-Camblor

et al. 2023

Journal of Hypertension

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Background and aims: Whether bedtime versus morning administration of antihypertensive therapy is beneficial on outcomes is controversial. We evaluated the risk of total and cardiovascular mortality in a very large observational cohort of treated hypertensive patients, according to the timing of their usual treatment administration (morning versus evening). Methods: Vital status and cause of death were obtained from death certificates of 28 406 treated hypertensive patients (mean age 62 years, 53% male individuals), enrolled in the Spanish Ambulatory Blood Pressure Monitoring (ABPM) Registry between 2004 and 2014. Among the 28 406 patients, most (86%) received their medication exclusively in the morning; whilst 13% were treated exclusively in the evening or at bedtime. Follow-up was for a median of 9.7 years and 4345 deaths occurred, of which 1478 were cardiovascular deaths. Results: Using Cox-models adjusted for clinical confounders and 24-h SBP, and compared with patients treated in the morning (reference group), all-cause mortality [hazard ratio 1.01; 95% CI 0.93–1.09) and cardiovascular mortality (hazard ratio 1.04; 95% CI 0.91–1.19) was not significantly different in those receiving evening medication dosing. The results were consistent in all the subgroups of patients analysed. Conclusion: In this very large observational study, morning versus bedtime dosing of antihypertensive medication made no difference to the subsequent risk of all-cause or cardiovascular mortality. These findings are in accordance with results from a recent randomized controlled trial and do not support the hypothesis of a specific beneficial effect of night-time antihypertensive treatment dosing on risk of all-cause or cardiovascular death.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of timing of antihypertensive treatment on mortality: an observational study from the Spanish Ambulatory Blood Pressure Monitoring Registry

de la Sierra,

Ruilope,

Martínez-Camblor

et al. 2023

Journal of Hypertension

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“…17 Further, nighttime BP is superior to daytime BP in predicting CVD-related events in younger and older individuals with and without hypertension. 18,19 Lack of nighttime BP dipping (i.e., non-dipping; ≤10% decrease in BP at night) 20 is also associated with CVD morbidities such as heart failure, stroke, and end target organ damage. 21 Black Americans exhibit an increased risk for elevated nighttime BP and attenuated nighttime BP dipping, 22 a phenomenon that may begin at an early age.…”

Section: Introductionmentioning

confidence: 99%

Interplay of Race and Neighborhood Deprivation on Ambulatory Blood Pressure in Young Adults

Jeong,

Linder,

Barnett

et al. 2023

Preprint

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BackgroundAmbulatory blood pressure (BP) monitoring measures nighttime BP and BP dipping, which are superior to in-clinic BP for predicting cardiovascular disease (CVD), the leading cause of death in America. Compared with other racial/ethnic groups, Black Americans exhibit elevated nighttime BP and attenuated BP dipping, including in young adulthood. Social determinants of health contribute to disparities in CVD risk, but the contribution of neighborhood deprivation on nighttime BP is unclear. Therefore, we examined associations between neighborhood deprivation with nighttime BP and BP dipping in young Black and White adults.MethodsWe recruited 21 Black and 26 White participants (20 M/27 F, mean age: 21 years, body mass index: 25±4 kg/m2) for 24-hour ambulatory BP monitoring. We assessed nighttime BP and BP dipping (nighttime:daytime BP ratio). The area deprivation index (ADI) was used to measure neighborhood deprivation. Associations between ADI and ambulatory BP were examined.ResultsBlack participants exhibited higher nighttime diastolic BP compared with White participants (63±8 mmHg vs 58±7 mmHg,p=0.003), and attenuated BP dipping ratios for both systolic (0.92±0.06 vs 0.86±0.05,p=0.001) and diastolic BP (0.86±0.09 vs 0.78±0.08,p=0.007). Black participants experienced greater neighborhood deprivation compared with White participants (ADI scores: 110±8 vs 97±21,p<0.001), and ADI was associated with attenuated systolic BP dipping (ρ=0.342,p=0.019).ConclusionsOur findings suggest neighborhood deprivation may contribute to higher nighttime BP and attenuated BP dipping, which are prognostic of CVD, and more prevalent in Black adults. Targeted interventions to mitigate the effects of neighborhood deprivation may help to improve nighttime BP.Clinical Trial RegistryURL:https://www.clinicaltrials.gov; Unique identifier:NCT04576338Clinical PerspectiveWe demonstrate young Black adults exhibit higher nighttime blood pressure and attenuated nighttime blood pressure dipping compared with young White adults.Black adults were exposed to greater neighborhood deprivation, which was associated with attenuated blood pressure dipping, irrespective of race.Our findings add to a growing body of literature indicating neighborhood deprivation may contribute to increased cardiovascular disease risk.

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Ultra-long-term efficacy and safety of catheter-based renal denervation in resistant hypertension: 10-year follow-up outcomes

Al Ghorani,

Kulenthiran,

Lauder

et al. 2024

Clin Res Cardiol

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Background Randomized sham-controlled trials have confirmed the efficacy and safety of catheter-based renal denervation in hypertension. Data on the very long-term effects of renal denervation are scarce. Aims This study evaluates the 10-year safety and efficacy of renal denervation in resistant hypertension. Methods This prospective single-center study included patients with resistant hypertension undergoing radio-frequency renal denervation between 2010 and 2012. Office blood pressure, 24-h ambulatory blood pressure, antihypertensive medication, color duplex sonography, and renal function were assessed after 1-, 2- and 10-years. Results Thirty-nine patients completed the 10-year follow-up (mean follow-up duration 9.4 ± 0.7 years). Baseline office and 24-h ambulatory systolic blood pressure were 164 ± 23 mmHg and 153 ± 16 mmHg, respectively. After 10 years, 24-h ambulatory and office systolic blood pressure were reduced by 16 ± 17 mmHg (P < 0.001) and 14 ± 23 mmHg (P = 0.001), respectively. The number of antihypertensive drugs remained unchanged from 4.9 ± 1.4 to 4.5 ± 1.2 drugs (P = 0.087). The estimated glomerular filtration rate declined within the expected range from 69 (95% CI 63 to 74) to 60 mL/min/1.73m2 (95% CI 53 to 68; P < 0.001) through 10-year follow-up. Three renal artery interventions were documented for progression of pre-existing renal artery stenosis in two patients and one patient with new-onset renal artery stenosis. No other adverse events were observed during the follow-up. Conclusion Renal denervation was safe and sustainedly reduced ambulatory and office blood pressure out to 10 years in patients with resistant hypertension. Graphical abstract Left panel, Change in 24-h and office SBP. Right panel, eGFR over time. SBP, systolic blood pressure; eGFR, estimated glomerular filtration rate.

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Relationship between clinic and ambulatory blood pressure and mortality: an observational cohort study in 59 124 patients

Cited by 102 publications

References 39 publications

Impact of timing of antihypertensive treatment on mortality: an observational study from the Spanish Ambulatory Blood Pressure Monitoring Registry

Impact of timing of antihypertensive treatment on mortality: an observational study from the Spanish Ambulatory Blood Pressure Monitoring Registry

Interplay of Race and Neighborhood Deprivation on Ambulatory Blood Pressure in Young Adults

Ultra-long-term efficacy and safety of catheter-based renal denervation in resistant hypertension: 10-year follow-up outcomes

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