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Isolated ambulatory hypertension predicts cardiovascular morbidity in elderly men
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
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2003 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 107, no 9, 1297-302 p.Article in journal (Refereed) Published
Abstract [en]

Background— Little is known about isolated ambulatory hypertension, a state with elevated ambulatory but normal office blood pressure (BP). This study aimed to investigate the prognostic significance of isolated ambulatory hypertension for cardiovascular morbidity in a population of elderly men.

Methods and Results— At baseline, 24-hour ambulatory BP and metabolic and cardiac risk profiles were evaluated in 578 untreated 70-year-old men, participants of a population-based cohort. Subjects with isolated ambulatory hypertension (office BP <140/90 and daytime BP ≥135/85) and sustained hypertension (office BP ≥140/90 and daytime BP ≥135/85) had increased plasma glucose, body mass index, and echocardiographically determined left ventricular relative wall thickness compared with normotensive subjects (office BP <140/90 and daytime BP <135/85). Seventy-two cardiovascular morbid events (2.37 per 100 person-years at risk) occurred over 8.4 years of follow-up. The prognostic value of isolated ambulatory and sustained hypertension was assessed with Cox proportional hazard regression. Multivariate models adjusting for serum cholesterol, smoking, and diabetes demonstrated that both isolated ambulatory hypertension (hazard ratio [HR], 2.77; 95% CI, 1.15 to 6.68) and sustained hypertension (HR, 2.94; 95% CI, 1.49 to 5.82) were independent predictors of cardiovascular morbidity. In a multivariate model with continuous BP variables, ambulatory daytime systolic BP (HR for 1 SD increase, 1.47; 95% CI, 1.09 to 1.97) was associated with an adverse outcome independently of office systolic BP.

Conclusions— In the present study, isolated ambulatory hypertension as well as sustained hypertension predicted cardiovascular morbidity. The findings suggest that 24-hour ambulatory BP monitoring may disclose important prognostic information also in subjects characterized as normotensive according to office BP.

Place, publisher, year, edition, pages
2003. Vol. 107, no 9, 1297-302 p.
Keyword [en]
Aged, Blood Pressure Monitoring; Ambulatory, Cardiovascular Diseases/epidemiology, Comparative Study, Heart Rate, Humans, Hypertension/*diagnosis/ultrasonography, Longitudinal Studies, Male, Middle Aged, Prognosis, Research Support; Non-U.S. Gov't, Risk Factors
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-90056DOI: 10.1161/​01.CIR.0000054622.45012.12PubMedID: 12628951OAI: oai:DiVA.org:uu-90056DiVA: diva2:162128
Available from: 2002-11-06 Created: 2002-11-06 Last updated: 2017-12-14Bibliographically approved
In thesis
1. 24-hour Ambulatory Blood Pressure - Relation to the Insulin Resistance Syndrome and Cardiovascular Disease
Open this publication in new window or tab >>24-hour Ambulatory Blood Pressure - Relation to the Insulin Resistance Syndrome and Cardiovascular Disease
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This study examined relationships between 24-hour ambulatory BP and components of the insulin resistance syndrome, and investigated the prognostic significance of 24-hour BP for cardiovascular morbidity in a longitudinal population-based study of 70-year-old men. The findings indicated, that a reduced nocturnal BP fall, nondipping, was a marker of increased risk primarily in subjects with diabetes. A low body mass index and a more favourable serum fatty acid composition at age 50 predicted the development of white-coat as opposed to sustained hypertension over 20 years. Furthermore, cross-sectionally determined hypertensive organ damage at age 70 was detected in sustained hypertensive but not in white-coat hypertensive subjects. In a prospective analysis, 24-hour ambulatory pulse pressure and systolic BP variability at age 70 were strong predictors of subsequent cardiovascular morbidity, independently of office BP and other established risk factors. Isolated ambulatory hypertension, defined as having a normal office BP but increased daytime ambulatory BP, was associated with a significantly increased incidence of cardiovascular events during follow-up.

Hypertension constitutes part of the insulin resistance syndrome, and is a common and powerful risk factor for cardiovascular disease in elderly. Blood pressure (BP) measured with 24-hour ambulatory monitoring gives however more detailed information and may be a better estimate of the true BP than conventional office BP.

In summary, these data provide further knowledge of 24-hour ambulatory BP and associated metabolic risk profile, and suggest that the prognostic value of 24-hour ambulatory BP is superior to conventional BP in an elderly population.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2002. 62 p.
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1199
Keyword
Medical sciences, hypertension, ambulatory blood pressure, insulin, fatty acids, prognosis, morbidity, MEDICIN OCH VÅRD
National Category
Medical and Health Sciences
Research subject
Geriatrics
Identifiers
urn:nbn:se:uu:diva-2871 (URN)91-554-5451-8 (ISBN)
Public defence
2002-11-29, Auditorium Minus, Museum Gustavianum, Uppsala, 13:15
Opponent
Available from: 2002-11-06 Created: 2002-11-06Bibliographically approved

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Björklund, KristinaLind, LarsZethelius, BjörnAndrén, Bertil

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