Outcome-driven thresholds for ambulatory pulse pressure in 9938 participants recruited from 11 populations

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

doi:10.1161/HYPERTENSIONAHA.113.02179

Outcome-driven thresholds for ambulatory pulse pressure in 9938 participants recruited from 11 populations

Yu-Mei Gu, Lutgarde Thijs, Yan Li, Kei Asayama, José Boggia, Tine W Hansen, Yan-Ping Liu, Takayoshi Ohkubo, Kristina Björklund-Bodegård, Jørgen Jeppesen, Eamon Dolan, Christian Torp-Pedersen, Tatiana Kuznetsova, Katarzyna Stolarz-Skrzypek, Valérie Tikhonoff, Sofia Malyutina, Edoardo Casiglia, Yuri Nikitin, Lars Lind, Edgardo SandoyaKalina Kawecka-Jaszcz, Yutaka Imai, Luis J Mena, Jiguang Wang, Eoin O'Brien, Peter Verhamme, Jan Filipovsky, Gladys E Maestre, Jan A Staessen, International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) Investigators

Department of Clinical Medicine

26 Citations (Scopus)

Abstract

Evidence-based thresholds for risk stratification based on pulse pressure (PP) are currently unavailable. To derive outcome-driven thresholds for the 24-hour ambulatory PP, we analyzed 9938 participants randomly recruited from 11 populations (47.3% women). After age stratification (<60 versus ≥60 years) and using average risk as reference, we computed multivariable-adjusted hazard ratios (HRs) to assess risk by tenths of the PP distribution or risk associated with stepwise increasing (+1 mm Hg) PP levels. All adjustments included mean arterial pressure. Among 6028 younger participants (68 853 person-years), the risk of cardiovascular (HR, 1.58; P=0.011) or cardiac (HR, 1.52; P=0.056) events increased only in the top PP tenth (mean, 60.6 mm Hg). Using stepwise increasing PP levels, the lower boundary of the 95% confidence interval of the successive thresholds did not cross unity. Among 3910 older participants (39 923 person-years), risk increased (P≤0.028) in the top PP tenth (mean, 76.1 mm Hg). HRs were 1.30 and 1.62 for total and cardiovascular mortality, and 1.52, 1.69, and 1.40 for all cardiovascular, cardiac, and cerebrovascular events. The lower boundary of the 95% confidence interval of the HRs associated with stepwise increasing PP levels crossed unity at 64 mm Hg. While accounting for all covariables, the top tenth of PP contributed less than 0.3% (generalized R(2) statistic) to the overall risk among the elderly. Thus, in randomly recruited people, ambulatory PP does not add to risk stratification below age 60; in the elderly, PP is a weak risk factor with levels below 64 mm Hg probably being innocuous.

Original language	English
Journal	Hypertension
Volume	63
Issue number	2
Pages (from-to)	229-237
Number of pages	9
ISSN	0194-911X
DOIs	https://doi.org/10.1161/HYPERTENSIONAHA.113.02179
Publication status	Published - Feb 2014

Keywords

Adult
Aged
Antihypertensive Agents
Blood Pressure Monitoring, Ambulatory
Evidence-Based Medicine
Female
Follow-Up Studies
Humans
Hypertension
Incidence
Male
Middle Aged
Proportional Hazards Models
Random Allocation
Risk Factors
Treatment Outcome

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10.1161/HYPERTENSIONAHA.113.02179

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Gu, Y-M., Thijs, L., Li, Y., Asayama, K., Boggia, J., Hansen, T. W., Liu, Y-P., Ohkubo, T., Björklund-Bodegård, K., Jeppesen, J., Dolan, E., Torp-Pedersen, C., Kuznetsova, T., Stolarz-Skrzypek, K., Tikhonoff, V., Malyutina, S., Casiglia, E., Nikitin, Y., Lind, L., ... International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) Investigators (2014). Outcome-driven thresholds for ambulatory pulse pressure in 9938 participants recruited from 11 populations. Hypertension, 63(2), 229-237. https://doi.org/10.1161/HYPERTENSIONAHA.113.02179

Gu, Y-M, Thijs, L, Li, Y, Asayama, K, Boggia, J, Hansen, TW, Liu, Y-P, Ohkubo, T, Björklund-Bodegård, K, Jeppesen, J, Dolan, E, Torp-Pedersen, C, Kuznetsova, T, Stolarz-Skrzypek, K, Tikhonoff, V, Malyutina, S, Casiglia, E, Nikitin, Y, Lind, L, Sandoya, E, Kawecka-Jaszcz, K, Imai, Y, Mena, LJ, Wang, J, O'Brien, E, Verhamme, P, Filipovsky, J, Maestre, GE, Staessen, JA & International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) Investigators 2014, 'Outcome-driven thresholds for ambulatory pulse pressure in 9938 participants recruited from 11 populations', Hypertension, vol. 63, no. 2, pp. 229-237. https://doi.org/10.1161/HYPERTENSIONAHA.113.02179

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title = "Outcome-driven thresholds for ambulatory pulse pressure in 9938 participants recruited from 11 populations",

abstract = "Evidence-based thresholds for risk stratification based on pulse pressure (PP) are currently unavailable. To derive outcome-driven thresholds for the 24-hour ambulatory PP, we analyzed 9938 participants randomly recruited from 11 populations (47.3% women). After age stratification (<60 versus ≥60 years) and using average risk as reference, we computed multivariable-adjusted hazard ratios (HRs) to assess risk by tenths of the PP distribution or risk associated with stepwise increasing (+1 mm Hg) PP levels. All adjustments included mean arterial pressure. Among 6028 younger participants (68 853 person-years), the risk of cardiovascular (HR, 1.58; P=0.011) or cardiac (HR, 1.52; P=0.056) events increased only in the top PP tenth (mean, 60.6 mm Hg). Using stepwise increasing PP levels, the lower boundary of the 95% confidence interval of the successive thresholds did not cross unity. Among 3910 older participants (39 923 person-years), risk increased (P≤0.028) in the top PP tenth (mean, 76.1 mm Hg). HRs were 1.30 and 1.62 for total and cardiovascular mortality, and 1.52, 1.69, and 1.40 for all cardiovascular, cardiac, and cerebrovascular events. The lower boundary of the 95% confidence interval of the HRs associated with stepwise increasing PP levels crossed unity at 64 mm Hg. While accounting for all covariables, the top tenth of PP contributed less than 0.3% (generalized R(2) statistic) to the overall risk among the elderly. Thus, in randomly recruited people, ambulatory PP does not add to risk stratification below age 60; in the elderly, PP is a weak risk factor with levels below 64 mm Hg probably being innocuous.",

keywords = "Adult, Aged, Antihypertensive Agents, Blood Pressure Monitoring, Ambulatory, Evidence-Based Medicine, Female, Follow-Up Studies, Humans, Hypertension, Incidence, Male, Middle Aged, Proportional Hazards Models, Random Allocation, Risk Factors, Treatment Outcome",

author = "Yu-Mei Gu and Lutgarde Thijs and Yan Li and Kei Asayama and Jos{\'e} Boggia and Hansen, {Tine W} and Yan-Ping Liu and Takayoshi Ohkubo and Kristina Bj{\"o}rklund-Bodeg{\aa}rd and J{\o}rgen Jeppesen and Eamon Dolan and Christian Torp-Pedersen 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 Yutaka Imai and Mena, {Luis J} and Jiguang Wang and Eoin O'Brien and Peter Verhamme and Jan Filipovsky and Maestre, {Gladys E} and Staessen, {Jan A} and {International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) Investigators}",

year = "2014",

month = feb,

doi = "10.1161/HYPERTENSIONAHA.113.02179",

language = "English",

volume = "63",

pages = "229--237",

journal = "Hypertension",

issn = "0194-911X",

publisher = "Lippincott Williams & Wilkins",

number = "2",

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TY - JOUR

T1 - Outcome-driven thresholds for ambulatory pulse pressure in 9938 participants recruited from 11 populations

AU - Gu, Yu-Mei

AU - Thijs, Lutgarde

AU - Li, Yan

AU - Asayama, Kei

AU - Boggia, José

AU - Hansen, Tine W

AU - Liu, Yan-Ping

AU - Ohkubo, Takayoshi

AU - Björklund-Bodegård, Kristina

AU - Jeppesen, Jørgen

AU - Dolan, Eamon

AU - Torp-Pedersen, Christian

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 - Imai, Yutaka

AU - Mena, Luis J

AU - Wang, Jiguang

AU - O'Brien, Eoin

AU - Verhamme, Peter

AU - Filipovsky, Jan

AU - Maestre, Gladys E

AU - Staessen, Jan A

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

PY - 2014/2

Y1 - 2014/2

N2 - Evidence-based thresholds for risk stratification based on pulse pressure (PP) are currently unavailable. To derive outcome-driven thresholds for the 24-hour ambulatory PP, we analyzed 9938 participants randomly recruited from 11 populations (47.3% women). After age stratification (<60 versus ≥60 years) and using average risk as reference, we computed multivariable-adjusted hazard ratios (HRs) to assess risk by tenths of the PP distribution or risk associated with stepwise increasing (+1 mm Hg) PP levels. All adjustments included mean arterial pressure. Among 6028 younger participants (68 853 person-years), the risk of cardiovascular (HR, 1.58; P=0.011) or cardiac (HR, 1.52; P=0.056) events increased only in the top PP tenth (mean, 60.6 mm Hg). Using stepwise increasing PP levels, the lower boundary of the 95% confidence interval of the successive thresholds did not cross unity. Among 3910 older participants (39 923 person-years), risk increased (P≤0.028) in the top PP tenth (mean, 76.1 mm Hg). HRs were 1.30 and 1.62 for total and cardiovascular mortality, and 1.52, 1.69, and 1.40 for all cardiovascular, cardiac, and cerebrovascular events. The lower boundary of the 95% confidence interval of the HRs associated with stepwise increasing PP levels crossed unity at 64 mm Hg. While accounting for all covariables, the top tenth of PP contributed less than 0.3% (generalized R(2) statistic) to the overall risk among the elderly. Thus, in randomly recruited people, ambulatory PP does not add to risk stratification below age 60; in the elderly, PP is a weak risk factor with levels below 64 mm Hg probably being innocuous.

AB - Evidence-based thresholds for risk stratification based on pulse pressure (PP) are currently unavailable. To derive outcome-driven thresholds for the 24-hour ambulatory PP, we analyzed 9938 participants randomly recruited from 11 populations (47.3% women). After age stratification (<60 versus ≥60 years) and using average risk as reference, we computed multivariable-adjusted hazard ratios (HRs) to assess risk by tenths of the PP distribution or risk associated with stepwise increasing (+1 mm Hg) PP levels. All adjustments included mean arterial pressure. Among 6028 younger participants (68 853 person-years), the risk of cardiovascular (HR, 1.58; P=0.011) or cardiac (HR, 1.52; P=0.056) events increased only in the top PP tenth (mean, 60.6 mm Hg). Using stepwise increasing PP levels, the lower boundary of the 95% confidence interval of the successive thresholds did not cross unity. Among 3910 older participants (39 923 person-years), risk increased (P≤0.028) in the top PP tenth (mean, 76.1 mm Hg). HRs were 1.30 and 1.62 for total and cardiovascular mortality, and 1.52, 1.69, and 1.40 for all cardiovascular, cardiac, and cerebrovascular events. The lower boundary of the 95% confidence interval of the HRs associated with stepwise increasing PP levels crossed unity at 64 mm Hg. While accounting for all covariables, the top tenth of PP contributed less than 0.3% (generalized R(2) statistic) to the overall risk among the elderly. Thus, in randomly recruited people, ambulatory PP does not add to risk stratification below age 60; in the elderly, PP is a weak risk factor with levels below 64 mm Hg probably being innocuous.

KW - Adult

KW - Aged

KW - Antihypertensive Agents

KW - Blood Pressure Monitoring, Ambulatory

KW - Evidence-Based Medicine

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Hypertension

KW - Incidence

KW - Male

KW - Middle Aged

KW - Proportional Hazards Models

KW - Random Allocation

KW - Risk Factors

KW - Treatment Outcome

U2 - 10.1161/HYPERTENSIONAHA.113.02179

DO - 10.1161/HYPERTENSIONAHA.113.02179

M3 - Journal article

C2 - 24324050

SN - 0194-911X

VL - 63

SP - 229

EP - 237

JO - Hypertension

JF - Hypertension

IS - 2

ER -

Outcome-driven thresholds for ambulatory pulse pressure in 9938 participants recruited from 11 populations

Abstract

Keywords

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