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Role of ambulatory blood pressure on prediction of cardiovascular disease. A cohort study


Ambulatory blood pressure (BP) is associated with mortality, but it is also interesting to expand its association with cardiovascular morbidity. This study sought to evaluate association with cardiovascular morbidity and cardiovascular mortality. Patients without cardiovascular disease who had a first 24-hour ambulatory BP monitoring were followed-up until the onset of the first event (a combined variable of cardiovascular mortality, coronary heart disease, cerebrovascular disease, peripheral arteriopathy, or hospital admission for heart failure). Changes in antihypertensive treatment couldn’t be collected. Cox regression analysis was adjusted for risk factors and office BP. We included 3907 patients (mean age, 58.0, SD 13.8 years), of whom 85.5% were hypertensive. The follow up period was 6.6 (95% CI 5.0–8.5) years. A total of 496 (12.7%) events were recorded. The incidence rate was 19.3 (95% CI 17.7–21.1) cases per 1000 person-years. The patients with an event compared to the rest of patients were mostly men, older, with higher office and ambulatory systolic BP, higher prevalence of diabetes, chronic kidney disease, dyslipidemia, and non-dipper or riser circadian profile. In the fully adjusted model, office BP loses its significant association with the main variable. Ambulatory BP association remained significant with cardiovascular morbidity and mortality, HR 1.494 (1.326–1.685) and 0.767 (0.654–0.899) for 24-hour systolic and diastolic BP, respectively. Nighttime systolic BP also maintained this significant association, 1.270 (1.016–1.587). We conclude that nighttime systolic BP and 24-hour BP are significantly associated with cardiovascular events and cardiovascular mortality in patients without cardiovascular disease attended under conditions of routine clinical practice.

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Fig. 1: Flow-Chart of the sample.
Fig. 2

Data availability

The data are not publicly available because of ethical restrictions related to protecting patient confidentiality.


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We thank all the investigators of the Spanish Ambulatory Blood Pressure Registry. A list with their names is available at


Supported by the Spanish Society of Hypertension and by an unrestricted grant from Lacer Laboratories, Spain. Specific funding for this analysis was obtained from a grant (PERIS SLT002/16/00061) from the Ministry of Health, Catalan Government (Generalitat de Catalunya).

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Authors and Affiliations



EV, CP, NS, MG, AS, LMR, JAD, MAM, JS were responsible for designing the protocol, writing the protocol, conducting the search, screening potentially eligible studies, interpreting results and writing the manuscript. AR was responsible for extracting and analyzing data, interpreting results, and creating’Summary of findings’ tables.

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Correspondence to Ernest Vinyoles.

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The authors declare no competing interests.

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This study was specifically approved by the IDIAP Jordi Gol Research Ethics Committee (resolution P17 / 078). All included patients signed the informed consent.

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Vinyoles, E., Puig, C., Roso-Llorach, A. et al. Role of ambulatory blood pressure on prediction of cardiovascular disease. A cohort study. J Hum Hypertens (2022).

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