Nighttime hypertension was associated with all-cause mortality (aHR 1.89; 95% CI 0.98-3.64; p=0.059) and had higher prognostic sensitivity than 24-hour or clinic blood pressure measurements.
Cohort (n=1,884)
No
Do nighttime blood pressure measurements predict all-cause mortality better than clinic or 24-hour measurements in adults in rural Kenya?
Nighttime blood pressure measurements provide superior prognostic sensitivity for all-cause mortality compared to clinic or 24-hour measurements in a rural African population.
Hazard Ratio: 1.89 (95% CI 0.98–3.64)
p-value: p=0.059
Objective: Evidence on the prognostic value of nighttime blood pressure (BP) measurements in low-resource settings is limited. We sought to determine the prognostic sensitivity and association of Nighttime blood pressure (BP) measurements with mortality in rural coastal Kenya. Design and method: We conducted a population-based cohort study within the Kilifi Health and Demographic Surveillance System in rural coastal Kenya. Adults aged 18 years or older were randomly selected from the general population and underwent 24-hour ambulatory BP monitoring (ABPM) between 2016 and 2018. The primary outcome was all-cause mortality through December 31, 2023. Associations between BP measures and mortality were assessed using Cox proportional hazards models adjusted for age, sex, body mass index, smoking status, antihypertensive medication use, urine sodium to potassium ratio and glycosylated haemoglobin. Results: A total of 1,884 participants were included; 1,060 (56%) were women, and the median (interquartile range) age at enrollment was 45 (24–59) years. During a median follow-up of 6.8 (6.0–7.1) years, 118 (5.2%) participants died. Cumulative mortality among individuals classified as having nighttime hypertension was 14% when applying ESC criteria and a risk of adjusted hazard ratio aHR, 1.89 95% CI, 0.98–3.64 p=0.059 Nighttime hypertension demonstrated higher prognostic sensitivity for mortality (81% 95% CI, 72–87% than the full 24-h BP monitoring (69% 59–77%) and clinic measurements (61% 52–70%) In models adjusted for demographic and clinical covariates, each half–standard deviation increase in nighttime systolic and diastolic BP was associated with mortality (aHR, 1.20 1.11–1.29 and 1.20 1.11–1.30, respectively). Associations between nighttime BP and mortality remained statistically significant after adjustment for clinic BP. However, clinic BP measurements were no longer associated with mortality after adjustment for 24-hour BP. Conclusions: Nighttime hypertension had high prognostic sensitivity and displayed independent associations with mortality compared to other BP indices.
Mwagwabi et al. (Fri,) conducted a cohort in Nighttime hypertension (n=1,884). Nighttime hypertension was evaluated on all-cause mortality (aHR 1.89, 95% CI 0.98-3.64, p=0.059). Nighttime hypertension was associated with all-cause mortality (aHR 1.89; 95% CI 0.98-3.64; p=0.059) and had higher prognostic sensitivity than 24-hour or clinic blood pressure measurements.