Blood pressure load does not add to ambulatory blood pressure level for cardiovascular risk stratification

Yan Li; Lutgarde Thijs; José Boggia; Kei Asayama; Tine W Hansen; Masahiro Kikuya; Kristina Björklund-Bodegård; Takayoshi Ohkubo; Jørgen Jeppesen; Christian Torp-Pedersen; Eamon Dolan; Tatiana Kuznetsova; Katarzyna Stolarz-Skrzypek; Valérie Tikhonoff; Sofia Malyutina; Edoardo Casiglia; Yuri Nikitin; Lars Lind; Edgardo Sandoya; Kalina Kawecka-Jaszcz; Jan Filipovsky; Yutaka Imai; Hans Ibsen; Eoin O'Brien; Jiguang Wang; Jan A Staessen; International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) Investigators*

doi:10.1161/hypertensionaha.113.02780

Blood pressure load does not add to ambulatory blood pressure level for cardiovascular risk stratification

Yan Li, Lutgarde Thijs, José Boggia, Kei Asayama, Tine W Hansen, Masahiro Kikuya, Kristina Björklund-Bodegård, Takayoshi Ohkubo, Jørgen Jeppesen, Christian Torp-Pedersen, Eamon Dolan, Tatiana Kuznetsova, Katarzyna Stolarz-Skrzypek, Valérie Tikhonoff, Sofia Malyutina, Edoardo Casiglia, Yuri Nikitin, Lars Lind, Edgardo Sandoya, Kalina Kawecka-JaszczJan Filipovsky, Yutaka Imai, Hans Ibsen, Eoin O'Brien, Jiguang Wang, Jan A Staessen, International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) Investigators*

Institut for Klinisk Medicin

23 Citationer (Scopus)

Abstract

Experts proposed blood pressure (BP) load derived from 24-hour ambulatory BP recordings as a more accurate predictor of outcome than level, in particular in normotensive people. We analyzed 8711 subjects (mean age, 54.8 years; 47.0% women) randomly recruited from 10 populations. We expressed BP load as percentage (%) of systolic/diastolic readings ≥135/≥85 mm Hg and ≥120/≥70 mm Hg during day and night, respectively, or as the area under the BP curve (mm Hg×h) using the same ceiling values. During a period of 10.7 years (median), 1284 participants died and 1109 experienced a fatal or nonfatal cardiovascular end point. In multivariable-adjusted models, the risk of cardiovascular complications gradually increased across deciles of BP level and load (P<0.001), but BP load did not substantially refine risk prediction based on 24-hour systolic or diastolic BP level (generalized R² statistic ≤0.294%; net reclassification improvement ≤0.28%; integrated discrimination improvement ≤0.001%). Systolic/diastolic BP load of 40.0/42.3% or 91.8/73.6 mm Hg×h conferred a 10-year risk of a composite cardiovascular end point similar to a 24-hour systolic/diastolic BP of 130/80 mm Hg. In analyses dichotomized according to these thresholds, increased BP load did not refine risk prediction in the whole study population (R ²<0.051) or in untreated participants with 24-hour ambulatory normotension (R²<0.034). In conclusion, BP load does not improve risk stratification based on 24-hour BP level. This also applies to subjects with normal 24-hour BP for whom BP load was proposed to be particularly useful in risk stratification.

Originalsprog	Engelsk
Tidsskrift	Hypertension
Vol/bind	63
Udgave nummer	5
Sider (fra-til)	925-933
Antal sider	9
ISSN	0194-911X
DOI	https://doi.org/10.1161/hypertensionaha.113.02780
Status	Udgivet - maj 2014

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10.1161/hypertensionaha.113.02780

https://www.ahajournals.org/doi/pdf/10.1161/HYPERTENSIONAHA.113.02780

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Li, Y., Thijs, L., Boggia, J., Asayama, K., Hansen, T. W., Kikuya, M., Björklund-Bodegård, K., Ohkubo, T., Jeppesen, J., Torp-Pedersen, C., Dolan, E., Kuznetsova, T., Stolarz-Skrzypek, K., Tikhonoff, V., Malyutina, S., Casiglia, E., Nikitin, Y., Lind, L., Sandoya, E., ... International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) Investigators* (2014). Blood pressure load does not add to ambulatory blood pressure level for cardiovascular risk stratification. Hypertension, 63(5), 925-933. https://doi.org/10.1161/hypertensionaha.113.02780

Li, Y, Thijs, L, Boggia, J, Asayama, K, Hansen, TW, Kikuya, M, Björklund-Bodegård, K, Ohkubo, T, Jeppesen, J, Torp-Pedersen, C, Dolan, E, Kuznetsova, T, Stolarz-Skrzypek, K, Tikhonoff, V, Malyutina, S, Casiglia, E, Nikitin, Y, Lind, L, Sandoya, E, Kawecka-Jaszcz, K, Filipovsky, J, Imai, Y, Ibsen, H, O'Brien, E, Wang, J, Staessen, JA & International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) Investigators* 2014, 'Blood pressure load does not add to ambulatory blood pressure level for cardiovascular risk stratification', Hypertension, bind 63, nr. 5, s. 925-933. https://doi.org/10.1161/hypertensionaha.113.02780

@article{76669f2f15224ad09bd7b5c057cce5fe,

title = "Blood pressure load does not add to ambulatory blood pressure level for cardiovascular risk stratification",

abstract = "Experts proposed blood pressure (BP) load derived from 24-hour ambulatory BP recordings as a more accurate predictor of outcome than level, in particular in normotensive people. We analyzed 8711 subjects (mean age, 54.8 years; 47.0% women) randomly recruited from 10 populations. We expressed BP load as percentage (%) of systolic/diastolic readings ≥135/≥85 mm Hg and ≥120/≥70 mm Hg during day and night, respectively, or as the area under the BP curve (mm Hg×h) using the same ceiling values. During a period of 10.7 years (median), 1284 participants died and 1109 experienced a fatal or nonfatal cardiovascular end point. In multivariable-adjusted models, the risk of cardiovascular complications gradually increased across deciles of BP level and load (P<0.001), but BP load did not substantially refine risk prediction based on 24-hour systolic or diastolic BP level (generalized R2 statistic ≤0.294%; net reclassification improvement ≤0.28%; integrated discrimination improvement ≤0.001%). Systolic/diastolic BP load of 40.0/42.3% or 91.8/73.6 mm Hg×h conferred a 10-year risk of a composite cardiovascular end point similar to a 24-hour systolic/diastolic BP of 130/80 mm Hg. In analyses dichotomized according to these thresholds, increased BP load did not refine risk prediction in the whole study population (R 2<0.051) or in untreated participants with 24-hour ambulatory normotension (R2<0.034). In conclusion, BP load does not improve risk stratification based on 24-hour BP level. This also applies to subjects with normal 24-hour BP for whom BP load was proposed to be particularly useful in risk stratification.",

keywords = "Adult, Aged, Area Under Curve, Blood Pressure, Blood Pressure Monitoring, Ambulatory, Cardiovascular Diseases, Circadian Rhythm, Female, Humans, Hypertension, Incidence, Male, Middle Aged, Multivariate Analysis, Predictive Value of Tests, Prospective Studies, Retrospective Studies, Risk Factors",

author = "Yan Li and Lutgarde Thijs and Jos{\'e} Boggia and Kei Asayama and Hansen, {Tine W} and Masahiro Kikuya and Kristina Bj{\"o}rklund-Bodeg{\aa}rd and Takayoshi Ohkubo and J{\o}rgen Jeppesen and Christian Torp-Pedersen and Eamon Dolan and Tatiana Kuznetsova and Katarzyna Stolarz-Skrzypek and Val{\'e}rie Tikhonoff and Sofia Malyutina and Edoardo Casiglia and Yuri Nikitin and Lars Lind and Edgardo Sandoya and Kalina Kawecka-Jaszcz and Jan Filipovsky and Yutaka Imai and Hans Ibsen and Eoin O'Brien and Jiguang Wang and Staessen, {Jan A} and {International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) Investigators*}",

year = "2014",

month = may,

doi = "10.1161/hypertensionaha.113.02780",

language = "English",

volume = "63",

pages = "925--933",

journal = "Hypertension",

issn = "0194-911X",

publisher = "Lippincott Williams & Wilkins",

number = "5",

}

TY - JOUR

T1 - Blood pressure load does not add to ambulatory blood pressure level for cardiovascular risk stratification

AU - Li, Yan

AU - Thijs, Lutgarde

AU - Boggia, José

AU - Asayama, Kei

AU - Hansen, Tine W

AU - Kikuya, Masahiro

AU - Björklund-Bodegård, Kristina

AU - Ohkubo, Takayoshi

AU - Jeppesen, Jørgen

AU - Torp-Pedersen, Christian

AU - Dolan, Eamon

AU - Kuznetsova, Tatiana

AU - Stolarz-Skrzypek, Katarzyna

AU - Tikhonoff, Valérie

AU - Malyutina, Sofia

AU - Casiglia, Edoardo

AU - Nikitin, Yuri

AU - Lind, Lars

AU - Sandoya, Edgardo

AU - Kawecka-Jaszcz, Kalina

AU - Filipovsky, Jan

AU - Imai, Yutaka

AU - Ibsen, Hans

AU - O'Brien, Eoin

AU - Wang, Jiguang

AU - Staessen, Jan A

AU - International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) Investigators

PY - 2014/5

Y1 - 2014/5

N2 - Experts proposed blood pressure (BP) load derived from 24-hour ambulatory BP recordings as a more accurate predictor of outcome than level, in particular in normotensive people. We analyzed 8711 subjects (mean age, 54.8 years; 47.0% women) randomly recruited from 10 populations. We expressed BP load as percentage (%) of systolic/diastolic readings ≥135/≥85 mm Hg and ≥120/≥70 mm Hg during day and night, respectively, or as the area under the BP curve (mm Hg×h) using the same ceiling values. During a period of 10.7 years (median), 1284 participants died and 1109 experienced a fatal or nonfatal cardiovascular end point. In multivariable-adjusted models, the risk of cardiovascular complications gradually increased across deciles of BP level and load (P<0.001), but BP load did not substantially refine risk prediction based on 24-hour systolic or diastolic BP level (generalized R2 statistic ≤0.294%; net reclassification improvement ≤0.28%; integrated discrimination improvement ≤0.001%). Systolic/diastolic BP load of 40.0/42.3% or 91.8/73.6 mm Hg×h conferred a 10-year risk of a composite cardiovascular end point similar to a 24-hour systolic/diastolic BP of 130/80 mm Hg. In analyses dichotomized according to these thresholds, increased BP load did not refine risk prediction in the whole study population (R 2<0.051) or in untreated participants with 24-hour ambulatory normotension (R2<0.034). In conclusion, BP load does not improve risk stratification based on 24-hour BP level. This also applies to subjects with normal 24-hour BP for whom BP load was proposed to be particularly useful in risk stratification.

AB - Experts proposed blood pressure (BP) load derived from 24-hour ambulatory BP recordings as a more accurate predictor of outcome than level, in particular in normotensive people. We analyzed 8711 subjects (mean age, 54.8 years; 47.0% women) randomly recruited from 10 populations. We expressed BP load as percentage (%) of systolic/diastolic readings ≥135/≥85 mm Hg and ≥120/≥70 mm Hg during day and night, respectively, or as the area under the BP curve (mm Hg×h) using the same ceiling values. During a period of 10.7 years (median), 1284 participants died and 1109 experienced a fatal or nonfatal cardiovascular end point. In multivariable-adjusted models, the risk of cardiovascular complications gradually increased across deciles of BP level and load (P<0.001), but BP load did not substantially refine risk prediction based on 24-hour systolic or diastolic BP level (generalized R2 statistic ≤0.294%; net reclassification improvement ≤0.28%; integrated discrimination improvement ≤0.001%). Systolic/diastolic BP load of 40.0/42.3% or 91.8/73.6 mm Hg×h conferred a 10-year risk of a composite cardiovascular end point similar to a 24-hour systolic/diastolic BP of 130/80 mm Hg. In analyses dichotomized according to these thresholds, increased BP load did not refine risk prediction in the whole study population (R 2<0.051) or in untreated participants with 24-hour ambulatory normotension (R2<0.034). In conclusion, BP load does not improve risk stratification based on 24-hour BP level. This also applies to subjects with normal 24-hour BP for whom BP load was proposed to be particularly useful in risk stratification.

KW - Adult

KW - Aged

KW - Area Under Curve

KW - Blood Pressure

KW - Blood Pressure Monitoring, Ambulatory

KW - Cardiovascular Diseases

KW - Circadian Rhythm

KW - Female

KW - Humans

KW - Hypertension

KW - Incidence

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Predictive Value of Tests

KW - Prospective Studies

KW - Retrospective Studies

KW - Risk Factors

U2 - 10.1161/hypertensionaha.113.02780

DO - 10.1161/hypertensionaha.113.02780

M3 - Journal article

C2 - 24535008

SN - 0194-911X

VL - 63

SP - 925

EP - 933

JO - Hypertension

JF - Hypertension

IS - 5

ER -

Blood pressure load does not add to ambulatory blood pressure level for cardiovascular risk stratification

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