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General medicine
Twenty-four-hour ambulatory systolic blood pressure may be a better predictor of all-cause and cardiovascular mortality than clinic blood pressure
  1. Michael Bursztyn1,
  2. Kei Asayama2
  1. 1 Hadassah-Hebrew University Medical Center, Jerusalem, Israel
  2. 2 Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
  1. Correspondence to Professor Michael Bursztyn, Hadassah-Hebrew University Medical Center, Jerusalem 9124001, Israel; bursz{at}

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Commentary on: Banegas JR, Ruilope LM, de la Sierra A, et al. Relationship between Clinic and Ambulatory Blood-Pressure Measurements and Mortality. N Engl J Med 2018;378:1509–1520.


Despite being generally accepted as the gold standard of blood pressure (BP) measurement. ambulatory blood pressure monitoring (ABPM) is still not universally accepted. Although cumulative evidence has revealed that night-time BP has better predictive power compared with daytime BP, American and International Society of Hypertension guidelines hardly mention it until 2017. There is intense controversy regarding the prognostic meaning of white-coat hypertension and to a lesser degree that of masked hypertension.


This study was a survival analysis of Spanish patients who had ABPM at their primary care clinics.1 Based on diaries, effects of 24 hours, daytime and night-time ABPM were examined along with clinic BP with adjustment for standard risk factors. White coat and masked hypertension were conventionally defined by the combination of 24-hour …

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  • Contributors Both authors had written and approved the commentary.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.