24-hour blood pressure monitoring is best way to predict cardiovascular diseases

An international study led by Professor Jan Staessen and Professor Zhen-Yu Zhang has shown that 24-hour blood pressure monitoring, including when the patient is asleep, has the highest predictive accuracy for cardiovascular diseases.

An international consortium followed 11,135 individuals for up to 14 years. Study participants included residents of twelve countries in Europe, East Asia, and Latin America. The researchers compared the predictive accuracy of blood pressure measurements by a healthcare provider in an office setting with repeated measurements over a 24-hour period.

“Our results show that repeated measurements over a 24-hour period most accurately capture the risk of cardiovascular diseases,” says Professor Staessen.

Automated blood pressure monitoring

The researchers performed individual blood pressure measurements using all available approaches. They also determined other risk factors. Study participants wore automated, portable monitors to allow for 24-hour monitoring.

The number of measurements averaged 30 during daytime and 10 during sleep. One of the advantages of measuring blood pressure during sleep, with individuals lying down in bed, is that the results are not influenced by activities or meals. This at least partly explains the accuracy of nighttime blood pressure measurements in predicting cardiac and vascular illness.

Improved monitoring of high blood pressure is more cost-effective than treating its complications, such as myocardial infarction and stroke.

“Our study is unique in its large sample size and long follow-up period,” explains Professor Staessen. “Moreover, the characteristics of participants were similar to those of the populations they represent.”

High blood pressure is the leading treatable risk factor for diseases of the heart and vascular system. Worldwide, high blood pressure causes 10 million deaths each year, with more than half of that mortality attributable to cardiovascular disease. “Our research highlights the necessity of using 24-hour measurements to diagnose high blood pressure,” said Professor Staessen.

Not reimbursed

“Most health insurers in Europe do not reimburse 24-hour ambulatory blood pressure monitoring. However, 24‑hour blood pressure monitoring during the daily activities of the patient is cost-effective, as it can detect cardiovascular diseases on time.” Moreover, improved monitoring of high blood pressure is more cost-effective than treating its complications, such as myocardial infarction and stroke.

“Prevention reduces the risk of premature disability and death, thereby avoiding a lot of suffering in patients and their families. About 30% of all adults and 60% of people over 60 have high blood pressure. Therefore, ambulatory blood pressure monitoring should be available at all levels of the healthcare delivery chain.”


The full text of the study “Association of Office and Ambulatory Blood Pressure With Mortality and Cardiovascular Outcomes” by, among others, Wen-YiYang, Jesus D. Melgarejo, Lutgarde Thijs, Zhen-Yu Zhang, and Jan Staessen was published in the Journal of the American Medical Association (JAMA).

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