Ambulatory Blood Pressure and 10-Year Risk of Cardiovascular and Noncardiovascular Mortality: The Ohasama Study

• Published in: Hypertension (Dallas, Tex. 1979) Vol. 45; no. 2; pp. 240 - 245
• Main Authors: Kikuya, Masahiro, Ohkubo, Takayoshi, Asayama, Kei, Metoki, Hirohito, Obara, Taku, Saito, Shin, Hashimoto, Junichiro, Totsune, Kazuhito, Hoshi, Haruhisa, Satoh, Hiroshi, Imai, Yutaka
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American Heart Association, Inc 01.02.2005; Hagerstown, MD Lippincott
• Subjects: Aged; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Cardiology. Vascular system; Cardiovascular Diseases - mortality; Circadian Rhythm; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Female; Fundamental and applied biological sciences. Psychology; Hemodynamics. Rheology; Humans; Longitudinal Studies; Male; Medical sciences; Middle Aged; Neoplasms - mortality; Prognosis; Proportional Hazards Models; Prospective Studies; Risk Assessment; Vertebrates: cardiovascular system; Human; Systolic pressure; Diastolic pressure; Prognosis; Mortality; Cardiovascular disease; cardiovascular diseases; Japanese; Survival; blood pressure monitoring, ambulatory; Risk factor; prospective studies; Predictive value; Rural area; Arterial pressure; Blood pressure; Ambulatory; Monitoring
• ISSN: 0194-911X; 1524-4563; 1524-4563
• DOI: 10.1161/01.HYP.0000152079.04553.2c

The objective of this study was to elucidate the long-term prognostic significance of ambulatory blood pressure. Ambulatory and casual blood pressure values were obtained from 1332 subjects (872 women and 460 men) aged ≥40 years from the general population of a rural Japanese community. Survival was then followed for 14 370 patient years and analyzed by a Cox hazard model adjusted for possible confounding factors. There were 72 cardiovascular deaths during the 10.8-year follow-up. The relationship between 24-hour systolic blood pressure and the cardiovascular mortality risk was U-shaped in the first 5 years, then changed to J-shaped over the rest of the 10.8-year follow-up. After censoring the first 2 years of data, the risk flattened until it again increased for the fifth quintile of 24-hour systolic blood pressure for the 10.8-year follow-up period. For 24-hour diastolic blood pressure, the J-shaped relationship remained unchanged, regardless of follow-up duration and censoring. Ambulatory systolic blood pressure values consistently showed stronger predictive power for cardiovascular mortality risk than did casual systolic blood pressure in the 10.8-year follow-up data, whereas such relationships became more marked after censoring the first 2 years. When nighttime and daytime systolic blood pressure values were simultaneously included in the same Cox model, only nighttime blood pressure significantly predicted the cardiovascular mortality risk for the 10.8-year follow-up data. We conclude that the relationship between ambulatory systolic blood pressure and cardiovascular mortality is not U-shaped or J-shaped, and that nighttime blood pressure has better prognostic value than daytime blood pressure.