Work

Impact of Office and Ambulatory Blood Pressure on Mortality in Patients with Coronary Heart Disease

Year: 2025

Type: article

Abstract: INTRODUCTION: There is scarce evidence on the prognostic impact of ambulatory blood pressure monitoring (ABPM) in patients with coronary heart disease (CHD). We aimed to investigate the risks of all-cause and cardiovascular mortality associated with office and ambulatory blood pressure (BP) in patients with CHD. METHODS: Prospective, observational study with 2679 patients (mean age 67 years, 35% women) with CHD, selected from the Spanish ABPM Registry. Associations between BP indices, as well as BP phenotypes, with all-cause and cardiovascular mortality were assessed by means of Cox-survival models adjusted for clinical confounders and alternative BP measures. RESULTS: During a median follow-up of 8.7 years, 740 patients (27.6%) died, 331 (12.4%) from cardiovascular causes. Office systolic BP was not associated with mortality, while 24-h (hazard ratio: 1.36; 95% confidence interval: 1.26-1.47), daytime (1.33; 1.23-1.44) and nighttime (1.33; 1.24-1.43) systolic BP were all associated with all-cause mortality, after adjustment for confounders and office BP. Masked hypertension (1.49; 1.10-2.01), sustained hypertension (1.46; 1.19-1.80), isolated daytime hypertension (1.80; 1.21-2.68) and isolated nighttime hypertension (1.33; 1.09-1.63), but not white-coat hypertension, were all associated with an increased risk of mortality compared to reference groups. A blunted nocturnal dipping (1.08; 1.01-1.16, for 1 standard deviation change in systolic night-to-day ratio) was also associated with an increased risk of death. Similar results were obtained for cardiovascular mortality. CONCLUSION: ABPM indices are more closely related with the risk of death than office BP in patients with CHD. These results emphasize the use of ABPM for a more accurate BP evaluation in this group of patients. Graphical abstract available for this article.

Source: Cardiology and Therapy

DOI: 10.1007/s40119-025-00437-1

Authors: Alejandro de la Sierra, Ernest Vinyoles, Manuel Gorostidi, Julián Segura, Luis M. Ruilope