Outcome-Driven Thresholds for Ambulatory Blood Pressure Based on the New American College of Cardiology/American Heart Association Classification of Hypertension. Issue 4 (October 2019)

• Record Type: Journal Article
• Authors: Cheng, Yi-Bang; Thijs, Lutgarde; Zhang, Zhen-Yu; Kikuya, Masahiro; Yang, Wen-Yi; Melgarejo, Jesus D.; Boggia, José; Wei, Fang-Fei; Hansen, Tine W.; Yu, Cai-Guo; Asayama, Kei; Ohkubo, Takayoshi; Dolan, Eamon; Stolarz-Skrzypek, Katarzyna; Malyutina, Sofia; Casiglia, Edoardo; Lind, Lars; Filipovský, Jan; Maestre, Gladys E.; Imai, Yutaka; Kawecka-Jaszcz, Kalina; Sandoya, Edgardo; Narkiewicz, Krzysztof; Li, Yan; O'Brien, Eoin; Wang, Ji-Guang; Staessen, Jan A.
• Is Part Of: Hypertension. Volume 74:Issue 4(2019)
• Publication Date: 2019-10
• Subjects: blood pressure monitoring, ambulatory -- hypertension -- United States; Hypertension -- Periodicals; Hypertension -- Treatment -- Periodicals; 616.132005
• DOI: 10.1161/HYPERTENSIONAHA.119.13512
• Languages: English
• ISSNs: 0194-911X

Abstract

Abstract : 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. Abstract : Supplemental Digital Content is available in the text.