title: Prognostic impact of sex-ambulatory blood pressure interactions in 10 cohorts of 17 312 patients diagnosed with hypertension: systematic review and meta-analysis.
abstract: BACKGROUND
  Whether ambulatory blood pressure (BP) among hypertensive patients better predicts cardiovascular events (CVEs) in women relative to men is unclear.
  
  
  METHODS
  We searched PUBMED and OVID databases. Cohorts were required to have hypertension, 1+ years of follow-up, with stroke and coronary artery disease as outcomes. Lead investigators for these cohorts provided ad hoc analyses. Random-effect meta-analyses gave hazard ratios for CVEs from a 1 standard deviation (SD) mmHg increase and a 10 mmHg increase in SBP. Subgroup and meta-regression analyses quantified the relative increase in risk in women versus men.
  
  
  RESULTS
  Patients were from Europe, Brazil, and Japan (10 cohorts, n = 17 312, CVEs = 1892). One cohort lacked sex-specific hazard ratios from 24 h and clinic SBP. Compared with men, women tended to have greater SDs and coefficients of variation of SBP. Subgroup analyses showed higher hazard ratios in women than in men from increases in ambulatory but not clinic SBPs. For women relative to men, a 1 SD increase in night-time, daytime, 24 h, and clinic SBP gave hazard ratios (95% confidence limits) of 1.17 (1.06-1.30), 1.24 (1.10-1.39), 1.21 (1.08-1.36), and 0.94 (0.84-1.05), respectively, whereas a 10 mmHg increase in SBP, gave hazard ratios of 1.06 (0.99-1.14), 1.13 (1.03-1.23), 1.10 (1.01-1.21), and 0.96 (0.89-1.03), respectively.
  
  
  CONCLUSIONS
  In patients with hypertension, increases in ambulatory, but not clinic, SBP predict higher risks for CVEs in women than in men. Although women tended to have greater variability in SBP, this did not entirely explain the sex-ambulatory BP interactions.
authors.affiliation: aABC-H, UCONN School of Medicine, St. Vincent's Medical Center, Bridgeport, Connecticut, USA bHypertension Unit, U.Z., University of Leuven, Leuven, Belgium cUniversity Hospital Clementino Fraga Filho, 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 University School of Medicine, Shimotsuke, Tochigi, Japan hFaculdade de Medicine 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 lUCONN School of Medicine, St. Vincent's Medical Center, Bridgeport, Connecticut, USA.
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: Jadesola
authors.initials: J
authors.lastname: Fapohunda
mesh_terms: D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D001938:Brazil; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000209:etiology*; D005060:Europe; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis*; D007564:Japan; D011237:Predictive Value of Tests; D011379:Prognosis; D012306:Risk; D012727:Sex Characteristics; D020521:Stroke / Q000209:etiology*