Diagnostic thresholds for ambulatory blood pressure monitoring based on 10-year cardiovascular risk.
BACKGROUND
Current diagnostic thresholds for ambulatory blood pressure (ABP) mainly rely on statistical parameters derived from reference populations. We determined an outcome-driven reference frame for ABP measurement.


RESULTS
We performed 24-hour ABP monitoring in 5682 participants (mean age 59.0 years; 43.3% women) enrolled in prospective population studies in Copenhagen, Denmark; Noorderkempen, Belgium; Ohasama, Japan; and Uppsala, Sweden. In multivariate analyses, we determined ABP thresholds, which yielded 10-year cardiovascular risks similar to those associated with optimal (120/80 mm Hg), normal (130/85 mm Hg), and high (140/90 mm Hg) blood pressure on office measurement. Over 9.7 years (median), 814 cardiovascular end points occurred, including 377 strokes and 435 cardiac events. Systolic/diastolic thresholds for optimal ABP were 116.8/74.2 mm Hg for 24 hours, 121.6/78.9 mm Hg for daytime, and 100.9/65.3 mm Hg for nighttime. Corresponding thresholds for normal ABP were 123.9/76.8, 129.9/82.6, and 110.2/68.1 mm Hg, respectively, and those for ambulatory hypertension were 131.0/79.4, 138.2/86.4, and 119.5/70.8 mm Hg. After rounding, approximate thresholds for optimal ABP amounted to 115/75 mm Hg for 24 hours, 120/80 mm Hg for daytime, and 100/65 mm Hg for nighttime. Rounded thresholds for normal ABP were 125/75, 130/85, and 110/70 mm Hg, respectively, and those for ambulatory hypertension were 130/80, 140/85, and 120/70 mm Hg.


CONCLUSIONS
Population-based outcome-driven thresholds for optimal and normal ABP are lower than those currently proposed by hypertension guidelines.
Kikuya
Masahiro
M
Tohoku University Graduate School of Pharmaceutical Science and Medicine, Sendai, Japan.
Hansen
Tine W
TW
Thijs
Lutgarde
L
Björklund-Bodegård
Kristina
K
Kuznetsova
Tatiana
T
Ohkubo
Takayoshi
T
Richart
Tom
T
Torp-Pedersen
Christian
C
Lind
Lars
L
Ibsen
Hans
H
Imai
Yutaka
Y
Staessen
Jan A
JA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001314:Auscultation; D001530:Belgium / Q000453:epidemiology; D018660:Blood Pressure Monitoring, Ambulatory / Q000295:instrumentation / Q000379:methods; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002940:Circadian Rhythm; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D003327:Coronary Disease / Q000453:epidemiology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D003718:Denmark / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D009991:Oscillometry; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012016:Reference Values; D015203:Reproducibility of Results; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D019722:Sphygmomanometers / Q000145:classification; D020521:Stroke / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology
D000959:Antihypertensive Agents