By contrast, ambulatory systolic pressure kept its predictive value after accounting for clinical systolic pressure, with a hazard ratio for all-cause mortality of 1.58 before and after the adjustment, they said in the report.
The strongest association with all-cause mortality was found in patients with masked hypertension – normal clinic readings but elevated ambulatory readings. The hazard ratio for all-cause mortality in that group was 2.83 when adjusted for clinic blood pressure, with similar findings reported for cardiovascular mortality.
White coat hypertension was also associated with increased risk of mortality. The finding of elevated clinic BP and normal 24-hour ambulatory BP had a hazard ratio of 1.79 for all-cause mortality after adjustment for clinic BP, results showed.
Ambulatory blood pressure rules hypertension diagnosis and follow-up
“In our study, white coat hypertension was not benign, which may be due in part to the higher mean blood pressure over 24 hours in these patients (119.9/71.9 mm Hg vs. 116.6/70.6 mm Hg in normotensive patients; P less than .001) or to their metabolic phenotype,” the investigators wrote.
Lacer Laboratories, the Spanish Society of Hypertension, and some European government agencies supported the study. Dr. Banegas reported grants from Fondo de Investigación Sanitaria and personal fees from Lacer. Coauthors reported disclosures related to Vascular Dynamics USA, Relypsa USA, Novartis Pharma USA, Daiichi Sankyo, Boehringer Ingelheim, Pfizer, Lacer Laboratories Spain, and others.
SOURCE: Banegas JR et al. N Engl J Med. 2018;378:1509-20.
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