TY - JOUR
T1 - Risk Stratification by Ambulatory Blood Pressure Monitoring Across JNC Classes of Conventional Blood Pressure
AU - Brguljan-Hitij, Jana
AU - Thijs, Lutgarde
AU - Li, Yan
AU - Hansen, Tine W
AU - Boggia, Jose
AU - Liu, Yan-Ping
AU - Asayama, Kei
AU - Wei, Fang-Fei
AU - Bjorklund-Bodegard, Kristina
AU - Gu, Yu-Mei
AU - Ohkubo, Takayoshi
AU - Jeppesen, Jorgen
AU - Torp-Pedersen, Christian
AU - Dolan, Eamon
AU - Kuznetsova, Tatiana
AU - Katarzyna, Stolarz-Skrzypek
AU - Tikhonoff, Valerie
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 - Wang, Jiguang
AU - O'Brien, Eoin
AU - Staessen, Jan A
AU - International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcome Investigators
N1 - © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: [email protected].
PY - 2014/7
Y1 - 2014/7
N2 - BACKGROUND Guidelines propose classification of conventional blood pressure (CBP) into normotension (<120/<80mm Hg), prehypertension (120-139/80-89mm Hg), and hypertension (≥140/≥90mm Hg). METHODS To assess the potential differential contribution of ambulatory blood pressure (ABP) in predicting risk across CBP strata, we analyzed outcomes in 7,826 untreated people recruited from 11 populations. RESULTS During an 11.3-year period, 809 participants died (276 cardiovascular deaths) and 639, 383, and 225 experienced a cardiovascular, cardiac, or cerebrovascular event. Compared with normotension (n = 2,639), prehypertension (n = 3,076) carried higher risk (P ≤ 0.015) of cardiovascular (+41%) and cerebrovascular (+92%) endpoints; compared with hypertension (n = 2,111) prehypertension entailed lower risk (P ≤ 0.005) of total mortality (-14%) and cardiovascular mortality (-29%) and of cardiovascular (-34%), cardiac (-33%), or cerebrovascular (-47%) events. Multivariable-adjusted hazard ratios (HRs) for stroke associated with 24-hour and daytime diastolic ABP (+5mm Hg) were higher (P ≤ 0.045) in normotension than in prehypertension and hypertension (1.98 vs.1.19 vs.1.28 and 1.73 vs.1.09 vs. 1.24, respectively) with similar trends (0.03 ≤ P ≤ 0.11) for systolic ABP (+10mm Hg). However, HRs for fatal endpoints and cardiac events associated with ABP did not differ significantly (P ≥ 0.13) across CBP categories. Of normotensive and prehypertensive participants, 7.5% and 29.3% had masked hypertension (daytime ABP ≥135/≥85mm Hg). Compared with true normotension (P ≤ 0.01), HRs for stroke were 3.02 in normotension and 2.97 in prehypertension associated with masked hypertension with no difference between the latter two conditions (P = 0.93). CONCLUSION ABP refines risk stratification in normotension and prehypertension mainly by enabling the diagnosis of masked hypertension.
AB - BACKGROUND Guidelines propose classification of conventional blood pressure (CBP) into normotension (<120/<80mm Hg), prehypertension (120-139/80-89mm Hg), and hypertension (≥140/≥90mm Hg). METHODS To assess the potential differential contribution of ambulatory blood pressure (ABP) in predicting risk across CBP strata, we analyzed outcomes in 7,826 untreated people recruited from 11 populations. RESULTS During an 11.3-year period, 809 participants died (276 cardiovascular deaths) and 639, 383, and 225 experienced a cardiovascular, cardiac, or cerebrovascular event. Compared with normotension (n = 2,639), prehypertension (n = 3,076) carried higher risk (P ≤ 0.015) of cardiovascular (+41%) and cerebrovascular (+92%) endpoints; compared with hypertension (n = 2,111) prehypertension entailed lower risk (P ≤ 0.005) of total mortality (-14%) and cardiovascular mortality (-29%) and of cardiovascular (-34%), cardiac (-33%), or cerebrovascular (-47%) events. Multivariable-adjusted hazard ratios (HRs) for stroke associated with 24-hour and daytime diastolic ABP (+5mm Hg) were higher (P ≤ 0.045) in normotension than in prehypertension and hypertension (1.98 vs.1.19 vs.1.28 and 1.73 vs.1.09 vs. 1.24, respectively) with similar trends (0.03 ≤ P ≤ 0.11) for systolic ABP (+10mm Hg). However, HRs for fatal endpoints and cardiac events associated with ABP did not differ significantly (P ≥ 0.13) across CBP categories. Of normotensive and prehypertensive participants, 7.5% and 29.3% had masked hypertension (daytime ABP ≥135/≥85mm Hg). Compared with true normotension (P ≤ 0.01), HRs for stroke were 3.02 in normotension and 2.97 in prehypertension associated with masked hypertension with no difference between the latter two conditions (P = 0.93). CONCLUSION ABP refines risk stratification in normotension and prehypertension mainly by enabling the diagnosis of masked hypertension.
KW - Adult
KW - Asia
KW - Blood Pressure
KW - Blood Pressure Determination
KW - Blood Pressure Monitoring, Ambulatory
KW - Cardiovascular Diseases
KW - Cohort Studies
KW - Europe
KW - Female
KW - Humans
KW - Hypertension
KW - Male
KW - Masked Hypertension
KW - Middle Aged
KW - Prehypertension
KW - Risk
KW - South America
KW - Stroke
U2 - 10.1093/ajh/hpu002
DO - 10.1093/ajh/hpu002
M3 - Journal article
C2 - 24572704
SN - 0895-7061
VL - 27
SP - 956
EP - 965
JO - American Journal of Hypertension
JF - American Journal of Hypertension
IS - 7
ER -
