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/<80 mm Hg), prehypertension (120-139/80-89 mm Hg), and hypertension (≥140/≥90 mm 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 (+5 mm 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 (+10 mm 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/≥85 mm 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/<80 mm Hg), prehypertension (120-139/80-89 mm Hg), and hypertension (≥140/≥90 mm 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 (+5 mm 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 (+10 mm 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/≥85 mm 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
VL - 27
SP - 956
EP - 965
JO - American Journal of Hypertension
JF - American Journal of Hypertension
SN - 0895-7061
IS - 7
ER -