title: Prognostic impact from clinic, daytime, and night-time systolic blood pressure in nine cohorts of 13,844 patients with hypertension.
abstract: METHODS
  To determine which SBP measure best predicts cardiovascular events (CVEs) independently, a systematic review was conducted for cohorts with all patients diagnosed with hypertension, 1+ years follow-up, and coronary artery disease and stroke outcomes. Lead investigators provided ad hoc analyses for each cohort. Meta-analyses gave hazard ratios from clinic SBP (CSBP), daytime SBP (DSBP), and night-time SBP (NSBP). Coefficients of variation of SBP measured dispersion. Nine cohorts (n = 13,844) were from Europe, Brazil, and Japan. For sleep-wake SBP classification, seven cohorts used patient-specific information.
  
  
  RESULTS
  Overall, NSBP's dispersion exceeded DSBP's dispersion by 22.6% with nonoverlapping confidence limits. Within all nine cohorts, dispersion for NSBP exceeded that for CSBP and DSBP. For each comparison, P = 0.004 that this occurred by chance. Considered individually, increases in NSBP, DSBP, and CSBP each predicted CVEs: hazard ratios (95% confidence intervals) = 1.25 (1.22-1.29), 1.20 (1.15-1.26), and 1.11 (1.06-1.16), respectively. However, after simultaneous adjustment for all three SBPs, hazard ratios were 1.26 (1.20-1.31), 1.01 (0.94-1.08), and 1.00 (0.95-1.05), respectively. Cohorts with baseline antihypertensive treatment and cohorts with patient-specific information for night-day BP classification gave similar results. Within most cohorts, simultaneously adjusted hazard ratios were greater for NSBP than for DSBP and CSBP: P = 0.023 and 0.012, respectively, that this occurred by chance.
  
  
  CONCLUSIONS
  In hypertensive patients, NSBP had greater dispersion than DSBP and CSBP in all cohorts. On simultaneous adjustment, compared with DSBP and CSBP, increased NSBP independently predicted higher CVEs in most cohorts, and, overall, NSBP independently predicted CVEs, whereas CSBP and DSBP lost their predictive ability entirely.
authors.affiliation: aUCONN School of Medicine, Farmington, Connecticut, USA bHypertension Unit, U.Z., University of Leuven, Leuven, Belgium cFaculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil dDipartimento di Medicina e Scienze dell'Invecchiamento, Universita Gabriele d'Annunzio, Chieti eDepartment of Internal Medicine, University of Perugia, Perugia fStruttura Complessa di Medicina, Ospedale di Assisi, Assisi, Italy gJichi Medical University School of Medicine, Shimotsuke, Tochigi Prefecture, Japan hFaculdade de Medicine da Universidade do Porto, Porto, Portugal iDepartment of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Terrassa jBioengineering and Chronobiology Laboratories, University of Vigo, Vigo, Spain kCambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: George C
authors.initials: GC
authors.lastname: Roush
authors.forename: Robert H
authors.initials: RH
authors.lastname: Fagard
authors.forename: Gil F
authors.initials: GF
authors.lastname: Salles
authors.forename: Sante D
authors.initials: SD
authors.lastname: Pierdomenico
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Reboldi
authors.forename: Paolo
authors.initials: P
authors.lastname: Verdecchia
authors.forename: Kazuo
authors.initials: K
authors.lastname: Eguchi
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hoshide
authors.forename: Jorge
authors.initials: J
authors.lastname: Polonia
authors.forename: Alejandro
authors.initials: A
authors.lastname: de la Sierra
authors.forename: Ramon C
authors.initials: RC
authors.lastname: Hermida
authors.forename: Eamon
authors.initials: E
authors.lastname: Dolan
authors.forename: Hernan
authors.initials: H
authors.lastname: Zamalloa
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis