Skip to content
2000
image of Predictive Accuracy of 24-Hour Ambulatory Blood Pressure Monitoring Versus Clinic Blood Pressure for Cardiovascular and All-Cause Mortality: A Systematic Review and Meta-Analysis

Abstract

Introduction

According to current clinical practice guidelines, Ambulatory Blood Pressure Measurement (ABPM) is recommended to confirm diagnoses of hypertension. It remains unclear as to which method is superior in predicting mortality outcomes.

Methods

Prospective observational studies, comparing ABPM with Clinical Blood Pressure Measurements (CBPM), were included with outcomes of the study being all-cause and cardiovascular mortality.

Results

Nine studies with a total of 23,140 participants were included. Each 10-mmHg increase in 24-hour mean systolic blood pressure (SBP) was linked to a higher risk of all-cause mortality (HR: 1.13, 95% CI: 1.09–1.18), while Clinic Blood Pressure Measurement (CBPM) was not a significant predictor (HR: 1.02, 95% CI: 0.90–1.13). Nighttime SBP increases of 10 mmHg were associated with a higher all-cause mortality risk than daytime SBP (HR: 1.16, 95% CI: 1.11–1.21 HR: 1.08, 95% CI: 1.05–1.12). For cardiovascular mortality, a 10 mmHg increase in SBP yielded an HR of 1.21 (95% CI: 1.16–1.27) for 24-hour ABPM compared to 1.08 (95% CI: 1.04–1.11) for CBPM. Similarly, for a 5 mmHg increase in Diastolic Blood Pressure (DBP), the HR was 1.14 (95% CI: 1.07–1.20) for 24 hour ABPM 1.04 (95% CI: 1.01–1.07) for clinical DBP, highlighting 24-hour monitoring as a stronger predictor for cardiovascular mortality.

Conclusion

The findings of this study support the superiority of ABPM measurements in predicting both all-cause and cardiovascular mortality.

Loading

Article metrics loading...

/content/journals/chyr/10.2174/0115734021337639250203175636
2025-02-11
2025-06-26
Loading full text...

Full text loading...

References

  1. Boateng E.B. Ampofo A.G. A glimpse into the future: Modelling global prevalence of hypertension. BMC Public Health 2023 23 1 1906 10.1186/s12889‑023‑16662‑z 37789258
    [Google Scholar]
  2. Stanaway J.D. Afshin A. Gakidou E. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: A systematic analysis for the global burden of disease study 2017. Lancet 2018 392 10159 1923 1994 10.1016/S0140‑6736(18)32225‑6 30496105
    [Google Scholar]
  3. Zhou B. Carrillo-Larco R.M. Danaei G. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: A pooled analysis of 1201 population-representative studies with 104 million participants. Lancet 2021 398 10304 957 980 10.1016/S0140‑6736(21)01330‑1 34450083
    [Google Scholar]
  4. Gulec S. Early diagnosis saves lives: Focus on patients with hypertension. Kidney Int. Suppl. 2013 3 4 332 334 10.1038/kisup.2013.69 25019014
    [Google Scholar]
  5. Unger T. Borghi C. Charchar F. 2020 international society of hypertension global hypertension practice guidelines. Hypertension 2020 75 6 1334 1357 10.1161/HYPERTENSIONAHA.120.15026 32370572
    [Google Scholar]
  6. Drawz P.E. Abdalla M. Rahman M. Blood pressure measurement: Clinic, home, ambulatory, and beyond. Am. J. Kidney Dis. 2012 60 3 449 462 10.1053/j.ajkd.2012.01.026 22521624
    [Google Scholar]
  7. Greenland P. Effective use of ambulatory blood pressure monitoring. JAMA 2019 322 5 420 421 10.1001/jama.2019.10123 31386117
    [Google Scholar]
  8. Parati G. Ochoa J.E. Bilo G. Moving beyond office blood pressure to achieve a personalized and more precise hypertension management. Hypertension 2017 70 3 e20 e31 10.1161/HYPERTENSIONAHA.117.08250 28760937
    [Google Scholar]
  9. Shimbo D. Abdalla M. Falzon L. Townsend R.R. Muntner P. Role of ambulatory and home blood pressure monitoring in clinical practice. Ann. Intern. Med. 2015 163 9 691 700 10.7326/M15‑1270 26457954
    [Google Scholar]
  10. Desai R. Dietrich E.A. Park H. Smith S.M. Out-of-pocket payment for ambulatory blood pressure monitoring among commercially insured in the United States. Am. J. Hypertens. 2020 33 11 999 1002 10.1093/ajh/hpaa120 32930343
    [Google Scholar]
  11. Hutton B. Salanti G. Caldwell D.M. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: Checklist and explanations. Ann. Intern. Med. 2015 162 11 777 784 10.7326/M14‑2385 26030634
    [Google Scholar]
  12. Lewington S. Clarke R. Qizilbash N. Peto R. Collins R. Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002 360 9349 1903 1913 10.1016/S0140‑6736(02)11911‑8 12493255
    [Google Scholar]
  13. Wells G.A. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2000 Available from: https://www.semanticscholar.org/paper/The-Newcastle-Ottawa-Scale-(NOS)-for-Assessing-the-Wells-Wells/c293fb316b6176154c3fdbb8340a107d9c8c82bf
    [Google Scholar]
  14. Dawes M.G. Coats A.J. Juszczak E. Daytime ambulatory systolic blood pressure is more effective at predicting mortality than clinic blood pressure. Blood Press. Monit. 2006 11 3 111 118 10.1097/01.mbp.0000209086.32493.bd 16702819
    [Google Scholar]
  15. Dolan E. Stanton A. Thijs L. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: The Dublin outcome study. Hypertension 2005 46 1 156 161 10.1161/01.HYP.0000170138.56903.7a 15939805
    [Google Scholar]
  16. Gąsowski J. Li Y. Kuznetsova T. Is “usual” blood pressure a proxy for 24-h ambulatory blood pressure in predicting cardiovascular outcomes? Am. J. Hypertens. 2008 21 9 994 1000 10.1038/ajh.2008.231 18600212
    [Google Scholar]
  17. Hansen T.W. Jeppesen J. Rasmussen S. Ibsen H. Torp-Pedersen C. Ambulatory blood pressure and mortality: A population-based study. Hypertension 2005 45 4 499 504 10.1161/01.HYP.0000160402.39597.3b 15753229
    [Google Scholar]
  18. Kikuya M. Ohkubo T. Asayama K. Ambulatory blood pressure and 10-year risk of cardiovascular and noncardiovascular mortality: The Ohasama study. Hypertension 2005 45 2 240 245 10.1161/01.HYP.0000152079.04553.2c 15596571
    [Google Scholar]
  19. Ohkubo T. Kikuya M. Metoki H. Prognosis of “masked” hypertension and “white-coat” hypertension detected by 24-h ambulatory blood pressure monitoring 10-year follow-up from the Ohasama study. J. Am. Coll. Cardiol. 2005 46 3 508 515 10.1016/j.jacc.2005.03.070 16053966
    [Google Scholar]
  20. Staessen J.A. Thijs L. Fagard R. Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. JAMA 1999 282 6 539 546 10.1001/jama.282.6.539 10450715
    [Google Scholar]
  21. Verdecchia P. Schillaci G. Borgioni C. Ciucci A. Pede S. Porcellati C. Ambulatory pulse pressure: A potent predictor of total cardiovascular risk in hypertension. Hypertension 1998 32 6 983 988 10.1161/01.HYP.32.6.983 9856961
    [Google Scholar]
  22. Wing L.M.H. Chowdhury E.K. Reid C.M. Beilin L.J. Brown M.A. Night-time ambulatory blood pressure is the best pretreatment blood pressure predictor of 11-year mortality in treated older hypertensives. Blood Press. Monit. 2018 23 5 237 243 10.1097/MBP.0000000000000331 29864033
    [Google Scholar]
  23. Verdecchia P. Reboldi G. Porcellati C. Risk of cardiovascular disease in relation to achieved office and ambulatory blood pressure control in treated hypertensive subjects. J. Am. Coll. Cardiol. 2002 39 5 878 885 10.1016/S0735‑1097(01)01827‑7 11869856
    [Google Scholar]
  24. Imai Y. Prognostic value of ambulatory and home blood pressures compared with office blood pressure in the general population: Follow-up results from the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study. Circulation 1996 111 14 1777 1783
    [Google Scholar]
  25. Ohkubo T. Imai Y. Tsuji I. Prediction of mortality by ambulatory blood pressure monitoring versus screening blood pressure measurements. J. Hypertens. 1997 15 4 357 364 10.1097/00004872‑199715040‑00006 9211170
    [Google Scholar]
  26. Khattar R.S. Senior R. Lahiri A. Cardiovascular outcome in white-coat versus sustained mild hypertension: A 10-year follow-up study. Circulation 1998 98 18 1892 1897 10.1161/01.CIR.98.18.1892 9799210
    [Google Scholar]
  27. Redon J. Campos C. Narciso M.L. Rodicio J.L. Pascual J.M. Ruilope L.M. Prognostic value of ambulatory blood pressure monitoring in refractory hypertension: A prospective study. Hypertension 1998 31 2 712 718 10.1161/01.HYP.31.2.712 9461245
    [Google Scholar]
  28. Zweiker R. Eber B. Schumacher M. Toplak H. Klein W. “Non-dipping” related to cardiovascular events in essential hypertensive patients. Acta Med. Austriaca 1994 21 3 86 89 7701925
    [Google Scholar]
  29. Piper M.A. Evans C.V. Burda B.U. Margolis K.L. O’Connor E. Whitlock E.P. Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: A systematic review for the U.S. preventive services task force. Ann. Intern. Med. 2015 162 3 192 204 10.7326/M14‑1539 25531400
    [Google Scholar]
  30. Verdecchia P. Prognostic value of ambulatory blood pressure: Current evidence and clinical implications. Hypertension 2000 35 3 844 851 10.1161/01.HYP.35.3.844 10720605
    [Google Scholar]
  31. Pickering T.G. Masked hypertension. Am Heart Assoc. 2002 795 796
    [Google Scholar]
  32. Whelton P.K. Carey R.M. Aronow W.S. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018 71 6 e13 e115 [published online November 13, 2017 29133356
    [Google Scholar]
  33. Gorostidi M. Vinyoles E. Banegas J.R. de la Sierra A. Prevalence of white-coat and masked hypertension in national and international registries. Hypertens. Res. 2015 38 1 1 7 10.1038/hr.2014.149 25319601
    [Google Scholar]
  34. Roush GC Fagard RH Salles GF Prognostic impact of sex-ambulatory blood pressure interactions in 10 cohorts of 17 312 pa-tients diagnosed with hypertension: systematic review and meta-analysis. J Hypertens. 2015 33 22 212 20 10.1097/HJH.0000000000000435 254790232
    [Google Scholar]
  35. Conen D. Bamberg F. Noninvasive 24-h ambulatory blood pressure and cardiovascular disease: A systematic review and meta-analysis. J. Hypertens. 2008 26 7 1290 1299 10.1097/HJH.0b013e3282f97854 18550999
    [Google Scholar]
  36. Greenberg J.A. Removing confounders from the relationship between mortality risk and systolic blood pressure at low and moderately increased systolic blood pressure. J. Hypertens. 2003 21 1 49 56 10.1097/00004872‑200301000‑00013 12544435
    [Google Scholar]
  37. Shimbo D. Abdalla M. Falzon L. Townsend R.R. Muntner P. Studies comparing ambulatory blood pressure and home blood pressure on cardiovascular disease and mortality out-comes: A systematic review. J. Am. Soc. Hypertens. 2016 10 3 224 234 10.1016/j.jash.2015.12.013
    [Google Scholar]
  38. Mancia G. Fagard R. Narkiewicz K. 2013 ESH/ESC Guidelines for the management of arterial hypertension. Eur. Heart J. 2013 34 28 2159 2219 10.1093/eurheartj/eht151 23771844
    [Google Scholar]
  39. McCormack T. Boffa R.J. Jones N.R. Carville S. McManus R.J. The 2018 ESC/ESH hypertension guideline and the 2019 NICE hypertension guideline, how and why they differ. Eur. Heart J. 2019 40 42 3456 3458 10.1093/eurheartj/ehz681 31589745
    [Google Scholar]
  40. Gabb G.M. Mangoni A.A. Anderson C.S. Guideline for the diagnosis and management of hypertension in adults — 2016. Med. J. Aust. 2016 205 2 85 89 10.5694/mja16.00526 27456450
    [Google Scholar]
  41. Shimamoto K. Ando K. Fujita T. The Japanese society of hypertension guidelines for the management of hypertension (JSH 2014). Hypertens. Res. 2014 37 4 253 390 10.1038/hr.2014.20 24705419
    [Google Scholar]
  42. Conen D. Ridker P.M. Buring J.E. Glynn R.J. Risk of cardiovascular events among women with high normal blood pressure or blood pressure progression: Prospective cohort study. BMJ 2007 335 7617 432 10.1136/bmj.39269.672188.AE 17704543
    [Google Scholar]
  43. Bjِrklund K, Lind L, Zethelius B, Andrén B, Lithell H. Isolated ambulatory hypertension predicts cardiovascular morbidity in elderly men. Circulation 2003 107 9 1297 1302 10.1161/01.CIR.0000054622.45012.12 12628951
    [Google Scholar]
  44. Clement D.L. De Buyzere M.L. De Bacquer D.A. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N. Engl. J. Med. 2003 348 24 2407 2415 10.1056/NEJMoa022273 12802026
    [Google Scholar]
  45. Ohkubo T. Hozawa A. Nagaie K. Prediction of stroke by ambulatory blood pressure monitoring versus screening blood pressure measurements in a general population. J. Hypertens. 2000 18 7 847 854 10.1097/00004872‑200018070‑00005 10930181
    [Google Scholar]
  46. Suzuki Y. Kuwajima I. Aono T. Prognostic value of nighttime blood pressure in the elderly: A prospective study of 24-hour blood pressure. Hypertens. Res. 2000 23 4 323 330 10.1291/hypres.23.323 10912768
    [Google Scholar]
  47. Aung K. Htay T. Relationship between outpatient clinic and ambulatory blood pressure measurements and mortality. Curr. Cardiol. Rep. 2019 21 5 28 10.1007/s11886‑019‑1114‑z 30880364
    [Google Scholar]
  48. Boggia J. Li Y. Thijs L. Prognostic accuracy of day versus night ambulatory blood pressure: A cohort study. Lancet 2007 370 9594 1219 1229 10.1016/S0140‑6736(07)61538‑4 17920917
    [Google Scholar]
  49. Staplin N de la Sierra A Ruilope LM Relationship between clinic and ambulatory blood pressure and mortality: An observational cohort study in 59 124 patients. Lancet. 2023 401 10393 2041 2050 10.1016/S0140‑6736(23)00733‑X 37156250
    [Google Scholar]
  50. Vischer A.S. Burkard T. Principles of blood pressure measurement - Current techniques, office vs ambulatory blood pressure measurement. Adv. Exp. Med. Biol. 2017 956 85 96
    [Google Scholar]
  51. Sega R Facchetti R Bombelli M Prognostic value of ambula-tory and home blood pressures compared with office blood pressure in the general population: Follow-up results from the Pressioni Arte-riose Monitorate e Loro Associazioni (PAMELA) study. Circulation 2005 111 14 1777 83 10.1161/01.CIR.0000160923.04524.5B 15809377
    [Google Scholar]
  52. Mancia G Facchetti R Bombelli M Grassi G Sega R Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure. Hypertension 2006 47 5 846 53 10.1161/01.HYP.0000215363.69793.bb 16567588
    [Google Scholar]
  53. Hansen T.W. Jeppesen J. Rasmussen S. Ibsen H. Torp-Pedersen C. Ambulatory blood pressure monitoring and risk of cardiovascular disease: A population based study. Am. J. Hypertens. 2006 19 3 243 250 10.1016/j.amjhyper.2005.09.018 16500508
    [Google Scholar]
  54. Dolan E Staessen JA O'Brien E Data from the Dublin outcome study. Blood Press Monit 2007 12 6 401 3 10.1097/MBP.0b013e328244df74 18277321
    [Google Scholar]
  55. Muxfeldt ES Cardoso CRL Salles GF Prognostic value of nocturnal blood pressure reduction in resistant hypertension. Arch Intern Med 2009 169 9 874 80 10.1001/archinternmed.2009.68 1943369
    [Google Scholar]
  56. Salles GF Cardoso CR Fonseca LL Fiszman R Muxfeldt ES Prognostic significance of baseline heart rate and its interaction with beta-blocker use in resistant hypertension: A cohort study. Am J of Hy-pertens 2013 26 2 218 226 10.1093/ajh/hps004 23382406
    [Google Scholar]
  57. Andreadis EA Geladari CV Angelopoulos ET Kolyvas GN Papademetriou V Morning surge and peak morning ambulatory blood pressure versus automated office blood pressure in predicting cardiovascular disease. High Blood Press Cardiovasc Prev 2019 26 3 209 215 10.1007/s40292‑019‑00315‑7 30989620
    [Google Scholar]
  58. Cardoso CRL Salles GC Salles GF Prognostic importance of on-treatment clinic and ambulatory blood pressures in resistant hypertension: A Cohort Study. Hypertension 2020 75 5 1184 1194 10.1161/HYPERTENSIONAHA.120.14782 32200673
    [Google Scholar]
/content/journals/chyr/10.2174/0115734021337639250203175636
Loading
/content/journals/chyr/10.2174/0115734021337639250203175636
Loading

Data & Media loading...

Supplements

PRISMA checklist is available as supplementary material on the publisher’s website along with the published article.

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test