Cohort study
Relationship between clinic and ambulatory blood pressure and mortality: an observational cohort study in 59 124 patients
- Observational cohort study
- registry-based
- 223 primary care centres
Authors' conclusion
Ambulatory blood pressure, particularly night-time blood pressure, was more informative about the risk of all-cause death and cardiovascular death than clinic blood pressure.
Study context
- Population
- Primary care patients referred for assessment of hypertension, Spanish Ambulatory Blood Pressure Registry, 2004–2014
- Participants
- 59,124 patients
- Exposure
- Clinic vs 24-h ambulatory BP as predictors of mortality
- Outcome
- All-cause and CV mortality
- Follow-up
- Median 9.7 years
Main finding
As reported in the abstract
All-cause death, per 1-SD increment (top four baseline-defined fifths)
Estimate (95% CI)
24-h systolic blood pressure
HR per 1-SD increment 1.41(1.36–1.47)
clinic systolic blood pressure
HR per 1-SD increment 1.18(1.13–1.23)
24-h blood pressureadjusted for clinic blood pressure
HR 1.43(1.37–1.49)
clinic blood pressureadjusted for 24-h blood pressure
HR 1.04(1.00–1.09)
Per 1-SD increment, as printed
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| All-cause mortality by BP phenotype vs BP within normal range — Masked hypertension vs Normal range | 1.24 (1.12–1.37) | |
| All-cause mortality by BP phenotype vs BP within normal range — Sustained hypertension vs Normal range | 1.24 (1.15–1.32) | |
| CV mortality by BP phenotype vs BP within normal range — Masked hypertension vs Normal range | 1.37 (1.15–1.63) | |
| CV mortality by BP phenotype vs BP within normal range — Sustained hypertension vs Normal range | 1.38 (1.22–1.55) | |
| 0.512Hazard ratio (log scale) |
Informativeness about risk vs clinic SBP (100%)
- Night-time SBP, all-cause death
- 591%
- Night-time SBP, CV death
- 604%
All-cause mortality by BP phenotype vs BP within normal range
- No elevated risk with white-coat hypertension
CV mortality by BP phenotype vs BP within normal range
- No elevated risk with white-coat hypertension
Original publication
Relationship between clinic and ambulatory blood pressure and mortality: an observational cohort study in 59 124 patients. Lancet. Published 5 May 2023. doi:10.1016/s0140-6736(23)00733-x
Summarised from the published abstract; every number is checked against it