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Outcome-Driven Thresholds for Ambulatory Blood Pressure Based on the New American College of Cardiology/American Heart Association Classification of Hypertension
Shanghai Jiao Tong Univ, Sch Med, Ctr Epidemiol Studies & Clin Trials, Shanghai, Peoples R China; Shanghai Jiao Tong Univ, Shanghai Inst Hypertens, Shanghai Key Lab Hypertens, Ctr Vasc Evaluat,Ruijin Hosp,Sch Med, Shanghai, Peoples R China.
Univ Leuven, Res Unit Hypertens & Cardiovasc Epidemiol, KU Leuven, Dept Cardiovasc Sci, Leuven, Belgium.
Univ Leuven, Res Unit Hypertens & Cardiovasc Epidemiol, KU Leuven, Dept Cardiovasc Sci, Leuven, Belgium.
Teikyo Univ, Dept Hyg & Publ Hlth, Sch Med, Tokyo, Japan.
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2019 (English)In: Hypertension, ISSN 0194-911X, E-ISSN 1524-4563, Vol. 74, no 4, p. 776-783Article in journal (Refereed) Published
Abstract [en]

The new American College of Cardiology/American Heart Association guideline reclassified office blood pressure and proposed thresholds for ambulatory blood pressure (ABP). We derived outcome-driven ABP thresholds corresponding with the new office blood pressure categories. We performed 24-hour ABP monitoring in 11 152 participants (48.9% women; mean age, 53.0 years) representative of 13 populations. We determined ABP thresholds resulting in multivariable-adjusted 10-year risks similar to those associated with elevated office blood pressure (120/80 mm Hg) and stages 1 and 2 of office hypertension (130/80 and 140/90 mm Hg). Over 13.9 years (median), 2728 (rate per 1000 person-years, 17.9) people died, 1033 (6.8) from cardiovascular disease; furthermore, 1988 (13.8), 893 (6.0), and 795 (5.4) cardiovascular and coronary events and strokes occurred. Using a composite cardiovascular end point, systolic/diastolic outcome-driven thresholds indicating elevated 24-hour, daytime, and nighttime ABP were 117.9/75.2, 121.4/79.6, and 105.3/66.2 mm Hg. For stages 1 and 2 ambulatory hypertension, thresholds were 123.3/75.2 and 128.7/80.7 mm Hg for 24-hour ABP, 128.5/79.6 and 135.6/87.1 mm Hg for daytime ABP, and 111.7/66.2 and 118.1/72.5 mm Hg for nighttime ABP. ABP thresholds derived from other end points were similar. After rounding, approximate thresholds for elevated 24-hour, daytime, and nighttime ABP were 120/75, 120/80, and 105/65 mm Hg, and for stages 1 and 2, ambulatory hypertension 125/75 and 130/80 mm Hg, 130/80 and 135/85 mm Hg, and 110/65 and 120/70 mm Hg. Outcome-driven ABP thresholds corresponding to elevated blood pressure and stages 1 and 2 of hypertension are similar to those proposed by the current American College of Cardiology/American Heart Association guideline.

Place, publisher, year, edition, pages
2019. Vol. 74, no 4, p. 776-783
Keywords [en]
blood pressure monitoring, ambulatory, hypertension, United States
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-395430DOI: 10.1161/HYPERTENSIONAHA.119.13512ISI: 000486010100011PubMedID: 31378104OAI: oai:DiVA.org:uu-395430DiVA, id: diva2:1365129
Funder
EU, European Research Council, 2011-294713-EPLOREEU, European Research Council, 713601-uPROPHETAvailable from: 2019-10-23 Created: 2019-10-23 Last updated: 2019-10-23Bibliographically approved

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