Diagnostic thresholds for ambulatory blood pressure monitoring based on 10-year cardiovascular risk.

Abstract:

BACKGROUND:Current diagnostic thresholds for ambulatory blood pressure (ABP) mainly rely on statistical parameters derived from reference populations. We determined an outcome-driven reference frame for ABP measurement. METHODS AND RESULTS:We performed 24-hour ABP monitoring in 5682 participants (mean age 59.0 years; 43.3% women) enrolled in prospective population studies in Copenhagen, Denmark; Noorderkempen, Belgium; Ohasama, Japan; and Uppsala, Sweden. In multivariate analyses, we determined ABP thresholds, which yielded 10-year cardiovascular risks similar to those associated with optimal (120/80 mm Hg), normal (130/85 mm Hg), and high (140/90 mm Hg) blood pressure on office measurement. Over 9.7 years (median), 814 cardiovascular end points occurred, including 377 strokes and 435 cardiac events. Systolic/diastolic thresholds for optimal ABP were 116.8/74.2 mm Hg for 24 hours, 121.6/78.9 mm Hg for daytime, and 100.9/65.3 mm Hg for nighttime. Corresponding thresholds for normal ABP were 123.9/76.8, 129.9/82.6, and 110.2/68.1 mm Hg, respectively, and those for ambulatory hypertension were 131.0/79.4, 138.2/86.4, and 119.5/70.8 mm Hg. After rounding, approximate thresholds for optimal ABP amounted to 115/75 mm Hg for 24 hours, 120/80 mm Hg for daytime, and 100/65 mm Hg for nighttime. Rounded thresholds for normal ABP were 125/75, 130/85, and 110/70 mm Hg, respectively, and those for ambulatory hypertension were 130/80, 140/85, and 120/70 mm Hg. CONCLUSIONS:Population-based outcome-driven thresholds for optimal and normal ABP are lower than those currently proposed by hypertension guidelines.

journal_name

Circulation

journal_title

Circulation

authors

Kikuya M,Hansen TW,Thijs L,Björklund-Bodegård K,Kuznetsova T,Ohkubo T,Richart T,Torp-Pedersen C,Lind L,Ibsen H,Imai Y,Staessen JA,International Database on Ambulatory blood pressure monitoring in relation to Cardiovascular Outcom

doi

10.1161/CIRCULATIONAHA.106.662254

subject

Has Abstract

pub_date

2007-04-24 00:00:00

pages

2145-52

issue

16

eissn

0009-7322

issn

1524-4539

pii

CIRCULATIONAHA.106.662254

journal_volume

115

pub_type

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