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Prognostic significance of ambulatory blood pressure in hypertensive patients with history of cardiovascular disease

Fagard, Robert H.a; Thijs, Lutgardea; Staessen, Jan A.a; Clement, Denis L.b; De Buyzere, Marc L.b; De Bacquer, Dirk A.c

doi: 10.1097/MBP.0b013e32831054f5
Original Articles

Objective To assess the prognostic significance of nighttime and daytime blood pressure (BP), their ratio and the nighttime dipping pattern for mortality and recurrent cardiovascular (CV) events in patients with CV disease at baseline.

Background The prognostic value of ambulatory BP has not been reported in hypertensive patients with a history of CV disease.

Methods We performed a meta-analysis on individual data of 302 patients with hypertension and CV disease from three prospective studies performed in Europe.

Results Age of the patients averaged 69±9 years; 50% were men and 62% were under antihypertensive treatment at the time of ambulatory BP monitoring. Office, daytime and nighttime BP averaged 161±20/86±12, 144±16/83±11 and 132±18/72±12 mmHg. Total follow-up time amounted to 2049 patient – years. Multivariable Cox regression analysis revealed that nighttime BP, but not daytime BP significantly predicted CV mortality (P≤0.05) and major CV events (P≤0.01) after adjustment for office BP and other confounders. When both nighttime and daytime BP were entered into the models, the predictive power of nighttime BP remained significant (P≤0.05); daytime BP did not add prognostic precision to nighttime BP. The systolic nightday BP ratio predicted all outcomes, and outcome was significantly worse in reverse dippers and nondippers than in dippers, both before and after adjustment for 24-h BP (P≤0.05).

Conclusion Nighttime BP is the better predictor of death and recurrent CV events in hypertensive patients with a history of CV disease. The night–day BP ratio and the dipping pattern significantly predict outcome, even after adjustment for 24-h BP.

aHypertension and Cardiovascular Rehabilitation Unit, Faculty of Medicine, University of Leuven KU Leuven

bDepartments of Cardiovascular Diseases

cPublic Health, Ghent University, Belgium

Correspondence to Robert Fagard, MD, PhD, Professor of Medicine, University of Leuven, Hypertension Unit, U.Z. Gasthuisberg, Herestraat 49, Leuven B-3000, Belgium

Tel: +32 16 34 87 07; fax: +32 16 34 37 66;


Received 2 June 2008 Revised 1 July 2008 Accepted 9 July 2008

© 2008 Lippincott Williams & Wilkins, Inc.