Ambulatory blood pressure provides a more comprehensive assessment than clinic blood pressure, and has been reported to better predict health outcomes than clinic or home pressure. We aimed to examine associations of clinic and 24-h ambulatory blood pressure with all-cause and cardiovascular mortality in a large cohort of primary care patients referred for assessment of hypertension. We did an observational cohort study using clinic and ambulatory blood pressure data obtained from March 1, 2004, to Dec 31, 2014, from the Spanish Ambulatory Blood Pressure Registry. This registry included patients from 223 primary care centres from the Spanish National Health System in all 17 regions of Spain. Mortality data (date and cause) were ascertained by a computerised search of the vital registry of the Spanish National Institute of Statistics. Complete data were available for age, sex, all blood pressure measures, and BMI. For each study participant, follow-up was from the date of their recruitment to the date of death or Dec 31, 2019, whichever occurred first. Cox models were used to estimate associations between usual clinic or ambulatory blood pressure and mortality, adjusted for confounders and additionally for alternative measures of blood pressure. For each measure of blood pressure, we created five groups (ie, fifths) defined by quintiles of that measure among those who subsequently died. During a median follow-up of 9·7 years, 7174 (12·1%) of 59 124 patients died, including 2361 (4·0%) from cardiovascular causes. J-shaped associations were observed for several blood pressure measures. Among the top four baseline-defined fifths, 24-h systolic blood pressure was more strongly associated with all-cause death (hazard ratio [HR] 1·41 per 1 – SD increment [95% CI 1·36–1·47]) than clinic systolic blood pressure (1·18 [1·13–1·23]). After adjustment for clinic blood pressure, 24-h blood pressure remained strongly associated with all-cause deaths (HR 1·43 [95% CI 1·37–1·49]), but the association between clinic blood pressure and all-cause death was attenuated when adjusted for 24-h blood pressure (1·04 [1·00–1·09]). Compared with the informativeness of clinic systolic blood pressure (100%), night-time systolic blood pressure was most informative about risk of all-cause death (591%) and cardiovascular death (604%). Relative to blood pressure within the normal range, elevated all-cause mortality risks were observed for masked hypertension (HR 1·24 [95% CI 1·12–1·37]) and sustained hypertension (1·24 [1·15–1·32]), but not white-coat hypertension, and elevated cardiovascular mortality risks were observed for masked hypertension (1·37 [1·15–1·63]) and sustained hypertension (1·38 [1·22–1·55]), but not white-coat hypertension. Ambulatory blood pressure, particularly night-time blood pressure, was more informative about the risk of all-cause death and cardiovascular death than clinic blood pressure. Spanish Society of Hypertension, Lacer Laboratories, UK Medical Research Council, Health Data Research UK, National Institute for Health and Care Research Biomedical Research Centres (Oxford and University College London Hospitals), and British Heart Foundation Centre for Research Excellence.

中文翻译：

---

临床血压和动态血压与死亡率之间的关系：一项针对 59 124 名患者的观察性队列研究

动态血压提供比诊所血压更全面的评估，并且据报道比诊所或家庭血压更能预测健康结果。我们的目的是在一大群转诊进行高血压评估的初级保健患者中检查临床血压和 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。我们使用西班牙动态血压登记处2004年3月1日至2014年12月31日期间获得的临床和动态血压数据进行了一项观察性队列研究。该登记册包括来自西班牙所有 17 个地区的西班牙国家卫生系统 223 个初级保健中心的患者。死亡率数据（日期和原因）是通过对西班牙国家统计研究所的生命登记册进行计算机化搜索来确定的。年龄、性别、所有血压测量值和体重指数都有完整的数据。对于每位研究参与者，随访时间为从招募之日起至死亡之日或 2019 年 12 月 31 日（以先发生者为准）。Cox 模型用于估计常规临床血压或动态血压与死亡率之间的关联，并针对混杂因素和其他血压测量方法进行了调整。对于每个血压测量值，我们创建了五个组（即五分之一），由随后死亡的血压测量值的五分位数定义。在中位随访 9·7 年期间，59 124 名患者中有 7174 名 (12·1%) 死亡，其中 2361 名 (4·0%) 死于心血管原因。在几种血压测量中观察到 J 形关联。在基线定义的前四个五分之一中，24 小时收缩压与全因死亡的相关性更强（每 1 – SD 增量的风险比 [HR] 1·41 [95% CI 1·36–1·47] ) 高于临床收缩压 (1·18 [1·13–1·23])。调整诊所血压后，24小时血压仍然与全因死亡密切相关（HR 1·43 [95% CI 1·37–1·49]），但诊所血压与全因死亡之间的关联当调整 24 小时血压 (1·04 [1·00–1·09]) 时，死亡人数减少。与临床收缩压（100%）的信息量相比，夜间收缩压对全因死亡（591%）和心血管死亡（604%）风险的信息量最大。相对于正常范围内的血压，观察到隐匿性高血压（HR 1·24 [95% CI 1·12–1·37]）和持续性高血压（1·24 [1·15– 1·32]），但白大衣高血压没有，并且观察到隐匿性高血压（1·37 [1·15–1·63]）和持续性高血压（1·38 [1·22–1]）心血管死亡风险升高。 ·55]），但不是白大衣高血压。动态血压，特别是夜间血压，比诊所血压更能提供有关全因死亡和心血管死亡风险的信息。西班牙高血压学会、Lacer 实验室、