Ambulatory blood pressure monitoring in 9357 subjects from 11 populations highlights missed opportunities for cardiovascular prevention in women.
To analyze sex-specific relative and absolute risks associated with blood pressure (BP), we performed conventional and 24-hour ambulatory BP measurements in 9357 subjects (mean age, 52.8 years; 47% women) recruited from 11 populations. We computed standardized multivariable-adjusted hazard ratios for associations between outcome and systolic BP. During a course of 11.2 years (median), 1245 participants died, 472 of cardiovascular causes. The number of fatal combined with nonfatal events was 1080, 525, and 458 for cardiovascular and cardiac events and for stroke, respectively. In women and men alike, systolic BP predicted outcome, irrespective of the type of BP measurement. Women compared with men were at lower risk (hazard ratios for death and all cardiovascular events=0.66 and 0.62, respectively; P<0.001). However, the relation of all cardiovascular events with 24-hour BP (P=0.020) and the relations of total mortality (P=0.023) and all cardiovascular (P=0.0013), cerebrovascular (P=0.045), and cardiac (P=0.034) events with nighttime BP were steeper in women than in men. Consequently, per a 1-SD decrease, the proportion of potentially preventable events was higher in women than in men for all cardiovascular events (35.9% vs 24.2%) in relation to 24-hour systolic BP (1-SD, 13.4 mm Hg) and for all-cause mortality (23.1% vs 12.3%) and cardiovascular (35.1% vs 19.4%), cerebrovascular (38.3% vs 25.9%), and cardiac (31.0% vs 16.0%) events in relation to systolic nighttime BP (1-SD, 14.1 mm Hg). In conclusion, although absolute risks associated with systolic BP were lower in women than men, our results reveal a vast and largely unused potential for cardiovascular prevention by BP-lowering treatment in women.
Studies Coordinating Centre, Laboratory of Hypertension, University of Leuven, Campus Sint Rafaël, Kapucijnenvoer 35, Block D, Level 00, Box 7001, B-3000 Leuven, Belgium. jan.staessen@med.kuleuven.be
José
J
Boggia
Lutgarde
L
Thijs
Tine W
TW
Hansen
Yan
Y
Li
Masahiro
M
Kikuya
Kristina
K
Björklund-Bodegård
Tom
T
Richart
Takayoshi
T
Ohkubo
Jørgen
J
Jeppesen
Christian
C
Torp-Pedersen
Eamon
E
Dolan
Tatiana
T
Kuznetsova
Agnieszka
A
Olszanecka
Valérie
V
Tikhonoff
Sofia
S
Malyutina
Edoardo
E
Casiglia
Yuri
Y
Nikitin
Lars
L
Lind
Gladys
G
Maestre
Edgardo
E
Sandoya
Kalina
K
Kawecka-Jaszcz
Yutaka
Y
Imai
Jiguang
J
Wang
Hans
H
Ibsen
Eoin
E
O'Brien
Jan A
JA
Staessen
D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate
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