BACKGROUND Evidence for the influence of ambulatory blood pressure on prognosis derives mainly from population-based studies and a few relatively small clinical investigations. This study examined the associations of blood pressure measured in the clinic (clinic blood pressure) and 24-hour ambulatory blood pressure with all-cause and cardiovascular mortality in a large cohort of patients in primary care. METHODS We analyzed data from a registry-based, multicenter, national cohort that included 63,910 adults recruited from 2004 through 2014 in Spain. Clinic and 24-hour ambulatory blood-pressure data were examined in the following categories: sustained hypertension (elevated clinic and elevated 24-hour ambulatory blood pressure), "white-coat" hypertension (elevated clinic and normal 24-hour ambulatory blood pressure), masked hypertension (normal clinic and elevated 24-hour ambulatory blood pressure), and normotension (normal clinic and normal 24-hour ambulatory blood pressure). Analyses were conducted with Cox regression models, adjusted for clinic and 24-hour ambulatory blood pressures and for confounders. RESULTS During a median follow-up of 4.7 years, 3808 patients died from any cause, and 1295 of these patients died from cardiovascular causes. In a model that included both 24-hour and clinic measurements, 24-hour systolic pressure was more strongly associated with all-cause mortality (hazard ratio, 1.58 per 1-SD increase in pressure; 95% confidence interval [CI], 1.56 to 1.60, after adjustment for clinic blood pressure) than the clinic systolic pressure (hazard ratio, 1.02; 95% CI, 1.00 to 1.04, after adjustment for 24-hour blood pressure). Corresponding hazard ratios per 1-SD increase in pressure were 1.55 (95% CI, 1.53 to 1.57, after adjustment for clinic and daytime blood pressures) for nighttime ambulatory systolic pressure and 1.54 (95% CI, 1.52 to 1.56, after adjustment for clinic and nighttime blood pressures) for daytime ambulatory systolic pressure. These relationships were consistent across subgroups of age, sex, and status with respect to obesity, diabetes, cardiovascular disease, and antihypertensive treatment. Masked hypertension was more strongly associated with all-cause mortality (hazard ratio, 2.83; 95% CI, 2.12 to 3.79) than sustained hypertension (hazard ratio, 1.80; 95% CI, 1.41 to 2.31) or white-coat hypertension (hazard ratio, 1.79; 95% CI, 1.38 to 2.32). Results for cardiovascular mortality were similar to those for all-cause mortality. CONCLUSIONS Ambulatory blood-pressure measurements were a stronger predictor of all-cause and cardiovascular mortality than clinic blood-pressure measurements. White-coat hypertension was not benign, and masked hypertension was associated with a greater risk of death than sustained hypertension. (Funded by the Spanish Society of Hypertension and others.).

中文翻译：

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临床和动态血压测量与死亡率之间的关系。

背景动态血压对预后影响的证据主要来自基于人群的研究和一些相对较小的临床研究。本研究调查了一大群初级保健患者的诊所测量血压（诊所血压）和 24 小时动态血压与全因死亡率和心血管死亡率之间的关系。方法 我们分析了基于登记的多中心全国队列数据，该队列包括 2004 年至 2014 年在西班牙招募的 63,910 名成年人。临床和24小时动态血压数据按以下类别进行检查：持续性高血压（临床升高和24小时动态血压升高）、“白大衣”高血压（临床升高和24小时动态血压正常） 、隐匿性高血压（正常门诊和 24 小时动态血压升高）和正常血压（正常门诊和正常 24 小时动态血压）。使用 Cox 回归模型进行分析，并根据临床血压和 24 小时动态血压以及混杂因素进行调整。结果 在中位随访 4.7 年期间，3808 名患者因任何原因死亡，其中 1295 名患者死于心血管原因。在包含 24 小时和临床测量的模型中，24 小时收缩压与全因死亡率的相关性更强（风险比，压力每增加 1-SD，风险比为 1.58；95% 置信区间 [CI]，1.56 至1.60，调整诊所血压后）高于诊所收缩压（风险比，1.02；95% CI，1.00至1.04，调整24小时血压后）。压力每增加 1-SD，对应的夜间动态收缩压风险比为 1.55（95% CI，1.53 至 1.57，调整临床和日间血压后），夜间动态收缩压为 1.54（95% CI，1.52 至 1.56，调整临床血压后）。和夜间血压）用于白天动态收缩压。这些关系在年龄、性别和肥胖、糖尿病、心血管疾病和抗高血压治疗方面的状况亚组中是一致的。隐匿性高血压与全因死亡率的相关性（风险比，2.83；95% CI，2.12 - 3.79）比持续性高血压（风险比，1.80；95% CI，1.41 - 2.31）或白大衣高血压（风险比，1.79；95% CI，1.38 至 2.32）。心血管死亡率的结果与全因死亡率的结果相似。结论 动态血压测量比诊所血压测量更能预测全因死亡率和心血管死亡率。白大衣高血压不是良性的，而隐匿性高血压比持续性高血压与更高的死亡风险相关。（由西班牙高血压协会等资助。）。