Prediction of strokes versus cardiac events by ambulatory monitoring of blood pressure: Results from an international database

Thomas G. Pickering, Joseph Schwartz, Paolo Verdecchia, Yutaka Imai, Kazuomi Kario, Kazuo Eguchi, Sante Pierdomenico, Takayoshi Ohkubo, Lindon Wing

Research output: Contribution to journalArticlepeer-review

21 Citations (Scopus)


We performed this study to elucidate the role of nighttime versus daytime ambulatory blood pressure in predicting stroke and cardiac events. The International Collaborative Study of the Prognostic Utility of ABPM, which includes prospective cohort studies of ambulatory blood pressure monitoring (ABPM) from seven sites, was analyzed in this study. The incidence of stroke and cardiac events were evaluated for an average of 5.8 years. A cox proportional hazards model of adjusting for site, age, sex, BMI, total cholesterol, smoking, and history of antihypertensive medications was used for the analysis. Dipping was defined as the percentage decline in nighttime systolic blood pressure (SBP) relative to daytime SBP. Three hundred and eleven cardiac events and 318 strokes were seen during the follow up periods. Awake and sleep SBP were both significantly associated with both cardiac and stroke events. When the awake and sleep SBP were entered together in the model, awake SBP was more strongly associated with cardiac events than sleep SBP (χ2 =12.4, d.f. =1, P = 0.0004); conversely, sleep SBP (χ2 =13.5, d.f. =1, P < 0.0002) was more predictive for stroke events than awake SBP, although awake SBP also remained a significant predictor (χ2 = 7.03, d.f. = 1, P = 0.008). The amount of dipping was a significant inverse predictor of stroke [hazards ratio (HR) 0.81 per 10% increase in dipping, confidence interval (CI) 0.70-0.94, χ2 = 7.70, d.f.= 1, P =0.006] but not of cardiac events. It should not be assumed that one summary measure of ambulatory blood pressure would be the best predictor of different clinical outcomes.

Original languageEnglish
Pages (from-to)397-399
Number of pages3
JournalBlood pressure monitoring
Issue number6
Publication statusPublished - 2007 Dec


  • Dipping
  • Myocardial infarction
  • Nocturnal blood pressure
  • Sleep

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine
  • Assessment and Diagnosis
  • Advanced and Specialised Nursing


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