Prognostic significance of 24-h ambulatory blood pressure characteristics for cardiovascular morbidity in a population of elderly men.
OBJECTIVE
This study aimed to investigate the prognostic significance of 24-h ambulatory systolic (SBP), diastolic (DBP) and pulse pressure (PP), and blood pressure (BP) variability for cardiovascular morbidity in elderly men.


METHODS
Twenty-four hour ABP monitoring was performed in 70-year-old men (n = 872) participating in a longitudinal population-based study. The population was followed for up to 9.5 years, and the relationship between different blood pressure components and cardiovascular (CV) morbidity was assessed by Cox proportional hazard analysis.


RESULTS
During follow-up, 172 CV events occurred (2.97 per 100 person-years). SBP and PP, both office and ambulatory, were significant predictors of CV morbidity. Twenty-four hour ambulatory PP [hazard ratio (HR) for 1 SD increase in BP 1.32, 95% confidence interval (CI) 1.15-1.52] and daytime ambulatory PP (HR 1.29, 95% CI 1.13-1.48) predicted CV morbidity independently of office PP and other established CV risk factors. Addition of night-time PP to a regression model with daytime PP and covariates did not increase the predictive value. However, the variability of daytime SBP (adjusted HR 1.24, 95% CI 1.07-1.42) provided additional prognostic power, independently of the 24-h SBP level.


CONCLUSIONS
Ambulatory PP was a powerful predictor of CV morbidity in elderly men, independently of office PP and other established cardiovascular risk factors. Moreover, variability of daytime SBP added important prognostic information, suggesting that 24-h ambulatory BP monitoring may contribute to an improved risk assessment in elderly subjects.
Department of Public Health and Caring Sciences, Section of Geriatrics, Uppsala University, Uppsala, Sweden. kristina.bjorklund@pubcare.uu.se
Kristina
K
Björklund
Lars
L
Lind
Björn
B
Zethelius
Lars
L
Berglund
Hans
H
Lithell
D000368:Aged; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D003327:Coronary Disease / Q000401:mortality; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000401:mortality