A comparison of the efficacy and duration of action of candesartan cilexetil and losartan as assessed by clinic and ambulatory blood pressure after a missed dose, in truly hypertensive patients: a placebo-controlled, forced titration study. Candesartan/Losartan study investigators

The purpose of this double-blind, forced titration study was to compare the antihypertensive effect duration of candesartan cilexetil, which has a longlasting binding to the human AT1-receptor, to that of losartan on ambulatory BP (ABP) not only during the 24-h dosing interval but also during the day of a missed dose intake. After a 4-week placebo lead-in period, 268 patients with sitting diastolic BP 95 to 110 mm Hg and mean awake ambulatory DBP > or =85 mm Hg were randomized to receive either 8 mg of candesartan, 50 mg of losartan, or placebo for a 4-week period. Thereafter, the doses were doubled in all patients for an additional 4-week period. Ambulatory BP monitoring was performed for 36 h after dosing and clinic BP measured 48 h after dosing. Candesartan cilexetil (16 mg) reduced ABP to a significantly greater extent than 100 mg of losartan, particularly for systolic ABP during daytime (P<.05), nighttime (P<.05), and 24-h (P<.01) periods, systolic (P<.01) and diastolic (P<.05) ABP between 0 and 36 h, and both systolic (P<.001) and diastolic (P<0.001) ABP during the day of a missed dose. Clinic BP at 48 h after dosing was significantly reduced exclusively with 16 mg of candesartan. The differences in BP reduction between 8 mg of candesartan and 50 mg of losartan were statistically significant for systolic ABP during daytime (P<.01), nighttime (P<.05), 24-h (P<.01), 0 to 36 h (P<.05) and during the day of missed dose (P<.05). Moreover, although losartan did not significantly reduce ambulatory BP in a dose-related manner, ambulatory systolic and diastolic BP reductions with 16 mg of candesartan were significantly greater (P<.01 and <.001) than those seen with 8 mg of candesartan during every period at the ABP supporting a dose-response relationship. In conclusion, this forced titration study in ambulatory hypertensive patients demonstrates that candesartan cilexetil provides significant dose-dependent reduction in both clinic and ambulatory BP in doses ranging from 8 to 16 mg once daily. Furthermore, candesartan cilexetil is superior to losartan in reducing systolic ABP and in controlling both systolic and diastolic ABP on the day of a missed dose. The differences observed between both agents are most likely attributable to a tighter binding to, and a slower dissociation from, the receptor binding site with candesartan cilexetil.     

Prevalence and clinical correlates of ambulatory blood pressure phenotypes in a Saudi hypertensive population

International Guidelines recommend ambulatory blood pressure monitoring (ABPM) for the management of hypertension. ABPM phenotypes predict outcomes independent of office blood pressure (BP). The authors explored the prevalence and clinical correlates of ABPM phenotypes and relationship with office BP in Saudi patients (n = 428, mean age 53.5 ± 14.6, 55% male) referred to a Specialist Hypertension clinic in Riyadh, Saudi Arabia. ABPM phenotypes included sustained normotension (27%), masked hypertension, MHT(32%), sustained hypertension, SHT(52%), and white coat hypertension(2.6%). MHT was more prevalent using asleep than 24‐hours (26.4% vs 12.9%, P < .01) or awake BP (26.4% vs 8.5%, P < .001) and observed in 85% of pre‐hypertensive patients. Isolated nocturnal hypertension was more prevalent in MHT vs SHT (70% vs 30%, P < .001). Office BP overestimated control rates compared with ABPM (48% vs 12.9%, P < .001). Our study shows that one in three Saudi patients will be managed inappropriately if office BP alone was relied upon for management of hypertension.     

Association of clinic and ambulatory blood pressure with new‐onset atrial fibrillation: A meta‐analysis of observational studies

The aim of this study was to perform a meta‐analysis of studies evaluating the association of clinic and daytime, nighttime, and 24‐h blood pressure with the occurrence of new‐onset atrial fibrillation. We conducted a literature search through PubMed, Web of science, and Cochrane Library for articles evaluating the occurrence of new‐onset atrial fibrillation in relation to the above‐mentioned blood pressure parameters and reporting adjusted hazard ratio and 95% confidence interval. We identified five studies. The pooled population consisted of 7224 patients who experienced 444 cases of atrial fibrillation. The overall adjusted hazard ratio (95% confidence interval) was 1.05 (0.98‐1.13), 1.19 (1.11‐1.27), 1.18 (1.11‐1.26), and 1.23 (1.14‐1.32), per 10‐mmHg increment in clinic, daytime, nighttime, and 24‐h systolic blood pressure, respectively. The degree of heterogeneity of the hazard ratio estimates across the studies (Q and I‐squared statistics) were minimal. The results of this meta‐analysis strongly suggest that ambulatory systolic blood pressure prospectively predicts incident atrial fibrillation better than does clinic systolic blood pressure and that daytime, nighttime, and 24‐h systolic blood pressure are similarly associated with future atrial fibrillation.     

Increased systolic ambulatory blood pressure and microalbuminuria in treated and non-treated hypertensive smokers

Objective: The primary aim of the present study was to evaluate the impact of smoking status on both clinic and ambulatory blood pressure (BP) and heart rate (HR) by using 24-h ambulatory BP monitoring in treated and non-treated hypertensive smokers and non-smokers. A secondary aim was to evaluate the interrelations between BP, smoking status and microalbuminuria. Design: Five hundred and eighty treated and non-treated hypertensive smokers and non-smokers were consecutively recruited. The patients were divided into groups of non-smokers (n = 414) and smokers (n = 166). We were able to match 115 smokers with 230 non-smokers with regard to clinic BP, gender and age. Methods: Microalbuminuria (albumin/creatinine ratio on morning spot urine sample), sitting clinic BP (mercury sphygmomanometry) and ambulatory BP (A&D TM 2421) were measured. Results: In the matched group we found a significant difference in ambulatory systolic and diastolic daytime BP between smokers and non-smokers (146.5 ± 15.0/90.6 ± 9.7 mmHg vs 142.3 ± 12.6/89.0 ± 9.0 mmHg). The smokers had significantly higher log albumin/creatinine ratio (0.51 ± 0.93 vs 0.19 ± 0.87). These results were found to be valid for treated as well as untreated patients. In both the matched and unmatched groups, the smokers had significantly higher HR. Conclusion: The higher daytime BP and HR as well as microalbuminuria in smokers may contribute to their increased cardiovascular risk. Furthermore, the higher ambulatory BP in smokers implicates that these patients tend to be underdiagnosed and undertreated if only clinic BP is used.     

高龄老年高血压患者动态血压和动态心电图特点及临床分析

目的分析高血压患者的24h动态血压、心电图的特点，并结合临床分析，为临床高龄老年高血压防治提供可参考依据。方法共入选老年高血压患者214例，按年龄分为两组，A组：高龄老年组（≥80岁）96例；B组：低龄老年组（60～79岁）118例。采用24h动态血压和24h动态心电图同步监测技术，记录血压和心电图变化，同时采集多次住院病历，观察高血压患者治疗过程中血压控制情况，心律失常以及靶器官损害发生情况。结果高龄老年组的大部分患者血压控制良好。24h动态血压水平两组之间仍有明显差异，高龄老年组心律失常、心脑血管事件次数、糖尿病、体重指数、左心室重量指数等均显著高于低龄老年组。结论与低龄老年组相比，80岁以上的高龄老年高血压患者肾损害明显，其24h动态血压水平与动态心电图改变及肾损害之间密切相关。     

动态血压监测评价国产坎地沙坦酯对高血压的疗效及安全性

目的 :观察国产坎地沙坦酯对原发性高血压 (EH)患者治疗的有效性、安全性及耐受性。方法 :EH患者 37例 ,整个研究过程包括 2周停药观察期和 8周治疗期。口服坎地沙坦酯 8mg ,qd ,在治疗 1、2、4、6和 8周末各随访 1次。服药 4周后若患者坐位舒张压 (DBP)≥ 90mmHg(1mmHg =0 .133kPa)则增加剂量至 16mg。在治疗开始时以及治疗期的第 8周进行 2 4h动态血压监测。结果 :①服药后 2 4h和白昼、夜间收缩压 (SBP)和DBP较服药前明显下降 ,分别为 (7.5 4± 12 .2 9) / (5 .19± 8.2 8) ,(6 .99± 14 .0 5 ) / (4 .6 2± 9.5 0 ) ,(8.4 8± 13.4 0 /(6 .0 2± 9.5 0 )mmHg ,均 P <0 .0 1。② 2 4h动态血压监测示服药后 2 4h各时点DBP和SBP均较服药前下降 ,大部分时点P <0 .0 5。③DBP、SBP的谷峰比率分别为 0 .70、0 .6 4。④平滑指数 (SI) :SBP、DBPSI分别为 3.99、3.10。⑤轻微不良反应发生率为 8.1% (3/ 37例 )。结论 :患者每日一次口服国产坎地沙坦酯 8～ 16mg治疗EH能持续 2 4h安全、平稳降压     

Twenty-four hour ambulatory blood pressure profile of a new,sustained-release preparation of nicardipine

Summary The 24-hour blood pressure (BP) profile of a new sustained-release preparation of nicardipine was assessed in 16 patients with essential hypertension (supine cuff diastolic BP>95 mmHg). Twenty-four hour ambulatory intraarterial BP monitoring (Oxford system) before treatment revealed a mean (SD) daytime BP of 174 (19) mmHg systolic and 105 (8) mmHg diastolic, and a mean nighttime BP of 142 (26) mmHg systolic and 83 (12) mmHg diastolic. Sustained release nicardipine (60 mg) was administered twice daily for 4–6 weeks and the ambulatory BP monitoring repeated. No significant change in heart rate occurred throughout the 24-hour period. However, there was a significant reduction (p<0.0001) in the mean daytime BP of 21 (13) mmHg systolic and 12 (9) mmHg diastolic and of mean nighttime BP of 21 (15) mmHg systolic and 13 (11) mmHg diastolic. A similar reduction in hourly mean BP occurred throughout the whole 24-hour period, including the steep early morning rise in BP. Although vasodilatory-type side effects occurred, they were generally mild to moderate and transient. This preparation produces a significant reduction in BP throughout the 24-hour period without reflex tachycardia.     

Prediction of atrial fibrillation in patients with hypertension: A comprehensive comparison of office and ambulatory blood pressure measurements

Hypertension is associated with the development of atrial fibrillation (AF). Evidence has shown that reverse dipping pattern, an abnormal increase of night‐time blood pressure (BP) comparing to daytime BP, is associated with cardiovascular events. However, the relationship between diurnal changes in BP and AF has not been sufficiently explored. This paper aims to cross‐sectionally explore the relationship between AF and ambulatory BP parameters, especially reverse dippers to the others, and further longitudinally analyze how BP patterns are associated to the risk of developing new‐onset AF. Between February 2012 and March 2021, five out of 412 patients were identified of AF at baseline; four were reverse dippers (3.7%) and one was from the others (.3%). Cross‐sectionally, the multivariate logistic regression analysis showed that reverse dippers were significantly more likely to have AF (odds ratio: 12.39, p = .030). After excluding patients with baseline AF, during the mean follow‐up of 4.6 ± 3.0 years, seven patients developed AF. Longitudinally, the multivariate Cox regression analysis revealed that 24‐h systolic BP (hazard ratio per 10 mmHg: 2.12, p = .015), night‐time systolic BP (hazard ratio per 10 mmHg: 2.27, p = .002), and presentation of reverse dipping (hazard ratio: 5.25, p = .042) were independently associated with new‐onset AF. None of the office BP measurements were associated with new‐onset AF. While ambulatory BP measurements were better predictors for the incidence of AF, careful management is necessary for reverse dippers as they are at high risk of developing AF.     

Twenty-four-hour blood pressure monitoring after a single dose of sustained-release verapamil

Summary The antihypertensive effect of a single dose of 240 mg sustained-release (S-R) verapamil was investigated by ambulatory blood pressure (BP) monitoring in 13 patients with mild to moderate essential hypertension. Following a 2-week washout period, 24-hour BP monitoring was carried out with a Spacelabs ICR 5300 device following random administration of a tablet of S-R verapamil or placebo; BP recording was repeated after crossover 3 to 7 days later. Average whole-day systolic and diastolic BPs were significantly lower after verapamil (130.1±2.6/87.1±1.2 mmHg) than after placebo (142.1±3.3/95.8±2.1 mmHg) (p<0.01). Mean waking BP was 146.4±3.6/99.1±2.2 mmHg after placebo and 135.2±3.3/90.5±1.7 mmHg after verapamil (p<0.01); during sleeping hours BP was 133.8±3.1/88.7±2.6 mmHg following placebo and 122.2±2.3/80.9±1.8 mmHg following verapamil (p<0.01). Blood pressure profile was significantly reduced by verapamil up to 20 hours after tablet administration, while from 21 to 24 hours after drug intake BP values were similar to placebo. Response to verapamil was not correlated to the pretreatment BP values and to the patient's age. In summary, this study suggests that acute administration of 240 mg S-R verapamil in hypertensive patients produces a BP reduction during 24-hour, daytime, and nighttime periods. The hypotensive efficacy is preserved for many hours after tablet intake and seems to be due to individual variation in cardiovascular reactivity to the drug.     

老年高血压患者动态血压负荷和脉搏波传导速度的相关性研究

目的探讨老年高血压患者24 h动态血压负荷与颈桡动脉脉搏波传导速度(crPWV)的相关性。方法选取60～79岁的老年原发性高血压患者187例,对所有入选对象进行24 h动态血压监测,根据获取的24 h动态血压监测参数分为杓型组90例与非杓型组97例,选择同期体检人群82例为正常对照组。所有受试者行24 h动态血压监测,应用脉搏波速度测定仪测定crPWV,并进行分析。结果杓型组及非杓型组24 h、昼间及夜间收缩压、舒张压负荷均显著高于正常对照组(P<0.01)。非杓型组夜间血压负荷较杓型组升高(P<0.05)。杓型组及非杓型组crPWV均较正常对照组升高(P<0.05)。控制性别、年龄因素后,老年高血压患者24 h收缩压、夜间收缩压负荷、昼间舒张压负荷是crPWV影响的主要因素。结论老年高血压患者动态血压负荷升高,大动脉顺应性降低,其中24 h收缩压、夜间收缩压负荷、昼间舒张压负荷是影响大动脉顺应性的主要危险因素。     

The relationship between casual and ambulatory blood pressure in essential hypertension: the influence of work, duration of hypertension and antihypertensive treatment

Casual blood pressure (BP) and ambulatory BP (mean 24-h BP) were determined in 23 untreated patients with essential hypertension and in 11 normotensive healthy control subjects. Mean 24-h BP was significantly lower than casual BP in patients with essential hypertension, but not in control subjects. This was demonstrated in the patients who did not work during the ambulatory BP monitoring and in the patients with newly recognized hypertension, whereas no differences were revealed either in the patients who went to work or had a known duration of hypertension longer than 6 months. The size of the difference between casual BP and mean 24-h BP was unaffected by antihypertensive therapy with metoprolol and also individually reproducible. An accordance between casual and ambulatory BP measurements in evaluation of the efficacy of antihypertensive treatment was found in 75% of the patients. Casual BP and mean 24-h BP were weakly correlated both before and during antihypertensive treatment. It is concluded that the higher casual BP than ambulatory BP in essential hypertension may be a specific characteristic of the disease. Both work and known duration of hypertension longer than 6 months eliminate the difference between casual ambulatory BP in essential hypertension. Ambulatory BP monitoring seems to be superior to casual BP measurements in the evaluation of antihypertensive treatment.     

高血压合并颈动脉粥样硬化患者动态血压特征分析

目的研究高血压合并颈动脉粥样硬化患者的动态血压特征和临床意义。方法选择高血压患者111例,行动态血压监测。所有患者行颈动脉超声检查,根据结果将患者分为斑块组66例和无斑块组45例,斑块组又根据斑块数量分为单一斑块组24例和多发斑块组42例。比较各组动态血压情况。结果斑块组较无斑块组患者24 h、昼间和夜间平均收缩压、舒张压和动脉压均显著增高(P<0.05),且斑块组非杓型血压发生率较无斑块组也显著增高(63.6%vs 44.4%,P<0.05);多发斑块组较单一斑块组患者24 h、昼间和夜间平均收缩压、舒张压和动脉压均显著增高(P<0.05),且多发斑块组非杓型血压发生率较单一斑块组显著增高(76.2%vs 41.7%,P<0.05)。结论持续血压升高是产生颈动脉粥样硬化的重要影响因素,且颈动脉斑块更易引发血压昼夜节律调节紊乱。     

Relationship between joint national committee-VI classification of hypertension and ambulatory blood pressure in patients with hypertension diagnosed by casual blood pressure

Background: White-coat hypertension has been diagnosed arbitrarily based on different criteria. In 1997, the Joint National Committee-VI (JNC-VI) reported a new classification of hypertension and strongly emphasized the importance of ambulatory blood pressure (ABP) monitoring. The report pronounced normal ABP values for the first time. Hypothesis: The study's aim was to clarify the relationship between casual blood pressure (BP) and ABP of patients with essential hypertension in each stage of JNC-VI classification, and the prevalence of white-coat hypertension diagnosed by using JNC-VI normal ABP criteria. Methods: Ambulatory blood pressure was monitored noninvasively in 232 patients with essential hypertension whose casual BP was ≥ 140/90 mmHg. The patients were classified according to JNC-VI classification, and their casual BP was compared with ABP. The criterion of white-coat hypertension was defined as casual BP ≥ 140/90 mmHg with normal ABP according to JNC-VI criteria (< 135/85 during daytime and < 120/75 during nighttime). Results: Mean ABP increased as the stage advanced, and the differences between casual BP and ABP also increased. There were considerable overlaps in the distribution of ABP among stages. The prevalence of white-coat hypertension was 13% overall: 30% of the patients with isolated systolic hypertension, 19% of those in stage 1,10% in stage 2, and 4% in stage 3. Conclusions: Classification of hypertension based on casual BP may not always correspond in severity to that based on ABP. Ambulatory blood pressure monitoring recommended by JNC-VI is very useful for the evaluation of hypertension to differentiate white-coat hypertension from true hypertension.     

阿托伐他汀对老年轻度高血压合并动脉粥样硬化患者疗效及动态血压分析刘波、韩冷、曹东来、何文兵、何俊

目的 探讨阿托伐他汀对老年轻度高血压合并动脉粥样硬化患者疗效及及其动态血压特征分析。方法 选择2011年3月至2014年12月我院收治的414例老年轻度高血压合并动脉粥样硬化患者,按就诊单双号随机分为对照组(常规治疗,202例)与观察组(常规治疗 阿托伐他汀,212例),两组患者均连续治疗24个月,比较两组治疗前后颈动脉粥样硬化斑块面积、颈动脉内膜中层厚度IMT、血脂(甘油三酯TG、总胆固醇TC、高密度脂蛋白HDL、低密度脂蛋白LDL、氧化低密度脂蛋白ox-LDL)水平变化及动态血压情况。结果 与治疗前比较,对照组与观察组IMT和颈动脉内膜斑块面积、TG、TC、LDL、ox-LDL水平均显著降低(P＜0.05),HDL水平则显著升高(P＜0.05),动态血压各项参数24h、昼间、夜间的平均收缩压、平均舒张压、平均动脉压均显著降低(P＜0.05);治疗后与对照组比较,观察A、B、C组的颈动脉内膜斑块面积与颈动脉IMT、TG、TC、LDL、ox-LDL水平均显著降低(P＜0.05),HDL水平显著升高(P＜0.05);24h、昼间、夜间的平均收缩压、平均舒张压、平均动脉压均显著降低(P＜0.05);颈动脉内膜斑块面积与颈动脉IMT、TG、TC、LDL、ox-LDL水平、24h、昼间、夜间的平均收缩压、平均舒张压、平均动脉压方面,观察组C较A明显降低,HDL明显升高,但A与B、B与C无明显差异(P＞0.05)。结论 阿托伐他汀联合抗高血压药物对于老年轻度高血压合并动脉粥样硬化患者疗效显著,低危因素情况可以考虑10mg/次,1次/d,高危因素可以考虑30mg/次,1次/d,有益于血压的控制,适于老年高血压合并动脉粥样硬化患者长期服用。     

Comparison of awake ambulatory blood pressure and automated office blood pressure using linear regression analysis in untreated patients in routine clinical practice

The recent American hypertension guidelines recommended a threshold of 130/80 mmHg to define hypertension on the basis of office, home or ambulatory blood pressure (BP). Despite recognizing the potential advantages of automated office (AO)BP, the recommendations only considered conventional office BP, without providing supporting evidence and without taking into account the well documented difference between office BP recorded in research studies versus routine clinical practice, the latter being about 10/7 mmHg higher. Accordingly, we examined the relationship between AOBP and awake ambulatory BP, which the guidelines considered to be a better predictor of future cardiovascular risk than office BP. AOBP readings and 24‐hour ambulatory BP recordings were obtained in 514 untreated patients referred for ambulatory BP monitoring in routine clinical practice. The relationship between mean AOBP and mean awake ambulatory BP was examined using linear regression analysis with and without adjustment for age and sex. Special attention was given to the thresholds of 130/80 and 135/85 mmHg, the latter value being the recognized threshold for defining hypertension using awake ambulatory BP, home BP and AOBP in other guidelines. The mean adjusted AOBP of 130/80 and 135/85 mmHg corresponded to mean awake ambulatory BP values of 132.1/81.5 and 134.4/84.6 mmHg, respectively. These findings support the use of AOBP as the method of choice for determining office BP in routine clinical practice, regardless of which of the two thresholds are used for diagnosing hypertension, with an AOBP of 135/85 mmHg being somewhat closer to the corresponding value for awake ambulatory BP.     

Left atrial size in 164 hypertensive patients: an echocardiographic and ambulatory blood pressure study

BACKGROUND: Left atrial enlargement (LAE) is associated with an increased risk of death and cardiovascular (CV) hospitalization. Whether or not LAE reflects early structural change from hypertension is unclear. HYPOTHESIS: The aim of this study was to evaluate the relationship between LA size, 24-h blood pressure measurements, age, body mass index (BMI), and left ventricular mass index (LVMI) in hypertensive patients. METHODS: We studied 164 outpatients (age range 30-76 years, 73 men and 91 women) with mild to moderate hypertension. Physical examination, electrocardiogram, noninvasive blood pressure monitoring (ABPM), Doppler echocardiogram were performed. Left ventricular mass index and LA dimensions were calculated. The sample was divided by age (< 60 and > or = 60 years). RESULTS: Left ventricular hypertrophy (LVH) was present in 45% of patients aged < 60 years and in 70% of patients aged > or = 60 years (p = 0.002). Left atrial enlargement (> 4 cm) was present in 35% of elderly and in 24% of young patients (p = 0.31), and in 36% of patients with and 21% of patients without LVH (p = 0.0057). There was no significant difference in the younger patients with and without LVH. The incidence of obesity was low (31%) in the whole sample. The percentage of overweight in the elderly patients with LVH and higher LA size was equally low. Multivariate analysis showed age (p = 0.044) and LVMI (p = 0.002) as the only significant predictors of LA enlargement. CONCLUSION: Since LAE is associated with a high risk of death and CV hospitalization, we emphasize the importance of development and use of drugs that inhibit LVH.     

Effects of different statin types and dosages on systolic/diastolic blood pressure: Retrospective analysis of 24‐hour ambulatory blood pressure database

We previously demonstrated lower diastolic blood pressure (BP) levels under statin therapy in adult individuals who consecutively underwent 24‐hour ambulatory BP monitoring and compared their levels to untreated outpatients. Here we evaluated systolic/diastolic BP levels according to different statin types and dosages. 987 patients (47.5% female, age 66.0 ± 10.1 years, BMI 27.7 ± 4.6 kg/m², clinic BP 146.9 ± 19.4/86.1 ± 12.1 mm Hg, 24‐hour BP 129.2 ± 14.4/74.9 ± 9.2 mm Hg) were stratified into 4 groups: 291 (29.5%) on simvastatin 10‐80 mg/d, 341 (34.5%) on atorvastatin 10‐80 mg/d, 187 (18.9%) on rosuvastatin 5‐40 mg/d, and 168 (17.0%) on other statins. There were no significant BP differences among patients treated by various statin types and dosages, except in lower clinic (P = .007) and daytime (P = .013) diastolic BP in patients treated with simvastatin and atorvastatin compared to other statins. Favorable effects of statins on systolic/diastolic BP levels seem to be independent of types or dosages, thus suggesting a potential class effect of these drugs.     

Ambulatory blood pressure and risk of new‐onset atrial fibrillation in treated hypertensive patients

The aim of this study was to evaluate the influence of clinic and ambulatory blood pressure (BP) on the occurrence of new‐onset atrial fibrillation (AF) in treated hypertensive patients. We studied 2135 sequential treated hypertensive patients aged >40 years. During the follow‐up (mean 9.7 years, range 0.4–20 years), 116 events (new‐onset AF) occurred. In univariate analysis, clinic, daytime, nighttime, and 24‐h systolic BP were all significantly associated with increased risk of new‐onset AF, that is, hazard ratio (95% confidence interval) per 10 mm Hg increment 1.22 (1.11–1.35), 1.36 (1.21–1.53), 1.42 (1.29–1.57), and 1.42 (1.26–1.60), respectively. After adjustment for various covariates in multivariate analysis, clinic systolic BP was no longer associated with increased risk of new‐onset AF, whereas daytime, nighttime, and 24‐h systolic BP remained significantly associated with outcome, that is, hazard ratio (95% confidence interval) per 10 mm Hg increment 1.09 (0.97–1.23), 1.23 (1.10–1.39), 1.16 (1.03–1.31), and 1.22 (1.06–1.40), respectively. Daytime, nighttime, and 24‐h systolic BP are superior to clinic systolic BP in predicting new‐onset AF in treated hypertensive patients. Future studies are needed to evaluate whether a better control of ambulatory BP might be helpful in reducing the occurrence of new‐onset AF.