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Opposing Age-Related Trends in Absolute and Relative Risk of Adverse Health Outcomes Associated With Out-of-Office Blood Pressure
Shanghai Jiao Tong Univ, Sch Med, Ctr Epidemiol Studies, Shanghai, Peoples R China;Shanghai Jiao Tong Univ, Clin Trials & Ctr Vasc Evaluat, Shanghai Inst Hypertens, Shanghai Key Lab Hypertens,Ruijin Hosp, Shanghai, Peoples R China.
Univ Leuven, Dept Cardiovasc Sci, KU Leuven, Res Unit Hypertens & Cardiovasc Epidemiol, Leuven, Belgium.
Univ Leuven, Dept Cardiovasc Sci, KU Leuven, Res Unit Hypertens & Cardiovasc Epidemiol, Leuven, Belgium.
Teikyo Univ, Sch Med, Dept Hyg & Publ Hlth, Tokyo, Japan;Tohoku Inst Management Blood Pressure, Sendai, Miyagi, Japan.
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2019 (English)In: Hypertension, ISSN 0194-911X, E-ISSN 1524-4563, Vol. 74, no 6, p. 1333-1342Article in journal (Refereed) Published
Abstract [en]

Participant-level meta-analyses assessed the age-specific relevance of office blood pressure to cardiovascular complications, but this information is lacking for out-of-office blood pressure. At baseline, daytime ambulatory (n=12 624) or home (n=5297) blood pressure were measured in 17 921 participants (51.3% women; mean age, 54.2 years) from 17 population cohorts. Subsequently, mortality and cardiovascular events were recorded. Using multivariable Cox regression, floating absolute risk was computed across 4 age bands (<= 60, 61-70, 71-80, and >80 years). Over 236 491 person-years, 3855 people died and 2942 cardiovascular events occurred. From levels as low as 110/65 mm Hg, risk log-linearly increased with higher out-of-office systolic/diastolic blood pressure. From the youngest to the oldest age group, rates expressed per 1000 person-years increased (P<0.001) from 4.4 (95% CI, 4.0-4.7) to 86.3 (76.1-96.5) for all-cause mortality and from 4.1 (3.9-4.6) to 59.8 (51.0-68.7) for cardiovascular events, whereas hazard ratios per 20-mm Hg increment in systolic out-of-office blood pressure decreased (P <= 0.0033) from 1.42 (1.19-1.69) to 1.09 (1.05-1.12) and from 1.70 (1.51-1.92) to 1.12 (1.07-1.17), respectively. These age-related trends were similar for out-of-office diastolic pressure and were generally consistent in both sexes and across ethnicities. In conclusion, adverse outcomes were directly associated with out-of-office blood pressure in adults. At young age, the absolute risk associated with out-of-office blood pressure was low, but relative risk high, whereas with advancing age relative risk decreased and absolute risk increased. These observations highlight the need of a lifecourse approach for the management of hypertension.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019. Vol. 74, no 6, p. 1333-1342
Keywords [en]
blood pressure, blood pressure monitoring, ambulatory, cardiovascular diseases, hypertension, mortality
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-398690DOI: 10.1161/HYPERTENSIONAHA.119.12958ISI: 000497370200017PubMedID: 30929514OAI: oai:DiVA.org:uu-398690DiVA, id: diva2:1376423
Funder
EU, European Research Council, 2011-294713-EPLOREEU, European Research Council, 713601-uP-ROPHETEU, FP7, Seventh Framework Programme, HEALTH-F7-305507 HOMAGEEU, FP7, Seventh Framework Programme, LSHM-CT-2006-037093EU, FP7, Seventh Framework Programme, HEALTH-F4-2007-201550Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2020-02-19Bibliographically approved

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