TY - JOUR
T1 - Outcome-Driven Thresholds for Ambulatory Blood Pressure Based on the New American College of Cardiology/American Heart Association Classification of Hypertension
AU - Cheng, Yi-Bang
AU - Thijs, Lutgarde
AU - Zhang, Zhen-Yu
AU - Kikuya, Masahiro
AU - Yang, Wen-Yi
AU - Melgarejo, Jesus D.
AU - Boggia, Jose
AU - Wei, Fang-Fei
AU - Hansen, Tine W.
AU - Yu, Cai-Guo
AU - Asayama, Kei
AU - Ohkubo, Takayoshi
AU - Dolan, Eamon
AU - Stolarz-Skrzypek, Katarzyna
AU - Malyutina, Sofia
AU - Casiglia, Edoardo
AU - Lind, Lars
AU - Filipovsky, Jan
AU - Maestre, Gladys E.
AU - Imai, Yutaka
AU - Kawecka-Jaszcz, Kalina
AU - Sandoya, Edgardo
AU - Narkiewicz, Krzysztof
AU - Li, Yan
AU - O'Brien, Eoin
AU - Wang, Ji-Guang
AU - Staessen, Jan A.
AU - IDACO Investigators
N1 - Funding Information:
The European Union (HEALTH-F7-305507 HOMAGE), the European Research Council (Advanced Researcher Grant 2011-294713-EPLORE and Proof-of-Concept Grant 713601-uPROPHET), the European Research Area Net for Cardiovascular Diseases (JTC2017-046-PROACT), and the Research Foundation Flanders, Ministry of the Flemish Community, Brussels, Belgium (G.0881.13), supported the Studies Coordinating Centre in Leuven. The European Union (grants LSHM-CT-2006–037093 and HEALTH-F4-2007–201550) also supported the research groups in Shanghai, Kraków, Padova, and Novosibirsk. The Ohasama Study was supported by Grants for Scientific Research (16H05243, 16K09472, 16K11850, 16K15359, 17H04126, 17H06533, 17K15853, 17K19930, 18K09674, 18K09904, and 18K17396) from the Ministry of Culture, Sports, Science, and Technology, Tokyo, Japan; a Grant-in-Aid for Young Scientists of Showa Pharmaceutical University H28-4; the Japan Arteriosclerosis Prevention Fund; Comprehensive Research on Cardiovascular and Lifestyle Related Diseases (H26-Junkankitou [Seisaku]-Ippan-001) and (H29–Junkankitou–Ippan–003) from the Ministry of Health, Labor, and Welfare, Tokyo, Japan; a Scheme to Revitalize Agriculture and Fisheries in Disaster Area through Deploying Highly Advanced Technology (NouEi 2-02) from the Ministry of Agriculture, Forestry and Fisheries, Japan. The Asociación Española Primera en Salud supported the research group in Montevideo. The Danish Heart Foundation (grant 01-2-9-9A-22914) and the Lundbeck Fonden (grant R32-A2740) supported the studies in Copenhagen. The JingNing study was supported by the National Natural Science Foundation of China (grants 81470533, 91639203, and 81770455), the Ministry of Science and Technology (2015AA020105-06, 2016YFC1300100, and 2018YFC1704902), Beijing, China, and by the Shanghai Commissions of Science and Technology (grants 14ZR1436200 and 15XD1503200) and the Shanghai Bureau of Health (15GWZK0802, 2017BR025, and a Grant for Leading Academics). The National Institutes of Health and the National Institute of Aging (5 R01 AG036469-05 and 1R03AG054186) and Fondo Nacional de Ciencia, Tecnología e Innovación (G-97000726) supported the Maracaibo Aging Study. Follow-up of the Kraków cohort was supported by the Foundation for Polish Science.
Publisher Copyright:
© 2019 American Heart Association, Inc.
PY - 2019/10
Y1 - 2019/10
N2 - The new American College of Cardiology/American Heart Association guideline reclassified office blood pressure and proposed thresholds for ambulatory blood pressure (ABP). We derived outcome-driven ABP thresholds corresponding with the new office blood pressure categories. We performed 24-hour ABP monitoring in 11 152 participants (48.9% women; mean age, 53.0 years) representative of 13 populations. We determined ABP thresholds resulting in multivariable-adjusted 10-year risks similar to those associated with elevated office blood pressure (120/80 mm Hg) and stages 1 and 2 of office hypertension (130/80 and 140/90 mm Hg). Over 13.9 years (median), 2728 (rate per 1000 person-years, 17.9) people died, 1033 (6.8) from cardiovascular disease; furthermore, 1988 (13.8), 893 (6.0), and 795 (5.4) cardiovascular and coronary events and strokes occurred. Using a composite cardiovascular end point, systolic/diastolic outcome-driven thresholds indicating elevated 24-hour, daytime, and nighttime ABP were 117.9/75.2, 121.4/79.6, and 105.3/66.2 mm Hg. For stages 1 and 2 ambulatory hypertension, thresholds were 123.3/75.2 and 128.7/80.7 mm Hg for 24-hour ABP, 128.5/79.6 and 135.6/87.1 mm Hg for daytime ABP, and 111.7/66.2 and 118.1/72.5 mm Hg for nighttime ABP. ABP thresholds derived from other end points were similar. After rounding, approximate thresholds for elevated 24-hour, daytime, and nighttime ABP were 120/75, 120/80, and 105/65 mm Hg, and for stages 1 and 2, ambulatory hypertension 125/75 and 130/80 mm Hg, 130/80 and 135/85 mm Hg, and 110/65 and 120/70 mm Hg. Outcome-driven ABP thresholds corresponding to elevated blood pressure and stages 1 and 2 of hypertension are similar to those proposed by the current American College of Cardiology/American Heart Association guideline.
AB - The new American College of Cardiology/American Heart Association guideline reclassified office blood pressure and proposed thresholds for ambulatory blood pressure (ABP). We derived outcome-driven ABP thresholds corresponding with the new office blood pressure categories. We performed 24-hour ABP monitoring in 11 152 participants (48.9% women; mean age, 53.0 years) representative of 13 populations. We determined ABP thresholds resulting in multivariable-adjusted 10-year risks similar to those associated with elevated office blood pressure (120/80 mm Hg) and stages 1 and 2 of office hypertension (130/80 and 140/90 mm Hg). Over 13.9 years (median), 2728 (rate per 1000 person-years, 17.9) people died, 1033 (6.8) from cardiovascular disease; furthermore, 1988 (13.8), 893 (6.0), and 795 (5.4) cardiovascular and coronary events and strokes occurred. Using a composite cardiovascular end point, systolic/diastolic outcome-driven thresholds indicating elevated 24-hour, daytime, and nighttime ABP were 117.9/75.2, 121.4/79.6, and 105.3/66.2 mm Hg. For stages 1 and 2 ambulatory hypertension, thresholds were 123.3/75.2 and 128.7/80.7 mm Hg for 24-hour ABP, 128.5/79.6 and 135.6/87.1 mm Hg for daytime ABP, and 111.7/66.2 and 118.1/72.5 mm Hg for nighttime ABP. ABP thresholds derived from other end points were similar. After rounding, approximate thresholds for elevated 24-hour, daytime, and nighttime ABP were 120/75, 120/80, and 105/65 mm Hg, and for stages 1 and 2, ambulatory hypertension 125/75 and 130/80 mm Hg, 130/80 and 135/85 mm Hg, and 110/65 and 120/70 mm Hg. Outcome-driven ABP thresholds corresponding to elevated blood pressure and stages 1 and 2 of hypertension are similar to those proposed by the current American College of Cardiology/American Heart Association guideline.
KW - COST-EFFECTIVENESS
KW - DIAGNOSIS
KW - HOME
KW - LEFT-VENTRICULAR HYPERTROPHY
KW - METAANALYSIS
KW - OFFICE
KW - PRIMARY-CARE
KW - United States
KW - ambulatory
KW - blood pressure monitoring
KW - hypertension
KW - Hypertension
KW - Blood pressure monitoring
KW - Ambulatory
U2 - 10.1161/HYPERTENSIONAHA.119.13512
DO - 10.1161/HYPERTENSIONAHA.119.13512
M3 - Article
C2 - 31378104
SN - 0194-911X
VL - 74
SP - 776
EP - 783
JO - Hypertension
JF - Hypertension
IS - 4
ER -