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Relationship between Clinic and Ambulatory Blood-Pressure Measurements and Mortality

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dc.contributor.author Banegas, José R.
dc.contributor.author Ruilope Urioste, Luis Miguel
dc.contributor.author Sierra, Alejandro de la
dc.contributor.author Vinyoles, Ernest
dc.contributor.author Gorostidi, Manuel
dc.contributor.author Cruz, Juan J. de la
dc.contributor.author Ruiz Hurtado, Gema
dc.contributor.author Segura, Julián
dc.contributor.author Rodríguez-Artalejo, Fernando
dc.contributor.author Williams, Bryan
dc.date.accessioned 2018-09-29T12:20:54Z
dc.date.available 2018-09-29T12:20:54Z
dc.date.issued 2018
dc.identifier.citation Banegas, J. R., Ruilope, L. M., de la Sierra, A., Vinyoles, E., Gorostidi, M., de la Cruz, J. J., ... & Williams, B. (2018). Relationship between clinic and ambulatory blood-pressure measurements and mortality. New England Journal of Medicine, 378(16), 1509-1520. DOI:10.1056/NEJMoa1712231 spa
dc.identifier.issn 1533-4406
dc.identifier.issn 0028-4793
dc.identifier.uri http://hdl.handle.net/11268/7439
dc.description.abstract BACKGROUND: Evidence for the influence of ambulatory blood pressure on prognosis derives mainly from population-based studies and a few relatively small clinical investigations. This study examined the associations of blood pressure measured in the clinic (clinic blood pressure) and 24-hour ambulatory blood pressure with all-cause and cardiovascular mortality in a large cohort of patients in primary care. METHODS: We analyzed data from a registry-based, multicenter, national cohort that included 63,910 adults recruited from 2004 through 2014 in Spain. Clinic and 24-hour ambulatory blood-pressure data were examined in the following categories: sustained hypertension (elevated clinic and elevated 24-hour ambulatory blood pressure), "white-coat" hypertension (elevated clinic and normal 24-hour ambulatory blood pressure), masked hypertension (normal clinic and elevated 24-hour ambulatory blood pressure), and normotension (normal clinic and normal 24-hour ambulatory blood pressure). Analyses were conducted with Cox regression models, adjusted for clinic and 24-hour ambulatory blood pressures and for confounders. RESULTS: During a median follow-up of 4.7 years, 3808 patients died from any cause, and 1295 of these patients died from cardiovascular causes. In a model that included both 24-hour and clinic measurements, 24-hour systolic pressure was more strongly associated with all-cause mortality (hazard ratio, 1.58 per 1-SD increase in pressure; 95% confidence interval [CI], 1.56 to 1.60, after adjustment for clinic blood pressure) than the clinic systolic pressure (hazard ratio, 1.02; 95% CI, 1.00 to 1.04, after adjustment for 24-hour blood pressure). Corresponding hazard ratios per 1-SD increase in pressure were 1.55 (95% CI, 1.53 to 1.57, after adjustment for clinic and daytime blood pressures) for nighttime ambulatory systolic pressure and 1.54 (95% CI, 1.52 to 1.56, after adjustment for clinic and nighttime blood pressures) for daytime ambulatory systolic pressure. These relationships were consistent across subgroups of age, sex, and status with respect to obesity, diabetes, cardiovascular disease, and antihypertensive treatment. Masked hypertension was more strongly associated with all-cause mortality (hazard ratio, 2.83; 95% CI, 2.12 to 3.79) than sustained hypertension (hazard ratio, 1.80; 95% CI, 1.41 to 2.31) or white-coat hypertension (hazard ratio, 1.79; 95% CI, 1.38 to 2.32). Results for cardiovascular mortality were similar to those for all-cause mortality. CONCLUSIONS: Ambulatory blood-pressure measurements were a stronger predictor of all-cause and cardiovascular mortality than clinic blood-pressure measurements. White-coat hypertension was not benign, and masked hypertension was associated with a greater risk of death than sustained hypertension. (Funded by the Spanish Society of Hypertension and others.). spa
dc.description.sponsorship SIN FINANCIACIÓN spa
dc.language.iso eng spa
dc.title Relationship between Clinic and Ambulatory Blood-Pressure Measurements and Mortality spa
dc.type article spa
dc.description.impact 79.258 JCR (2017) Q1, 1/154 Medicine, General & Internal spa
dc.identifier.doi 10.1056/NEJMoa1712231
dc.rights.accessRights closedAccess spa
dc.subject.uem Hipertensión spa
dc.subject.unesco Enfermedad cardiovascular spa
dc.description.filiation UEM spa
dc.peerreviewed Si spa


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