title: Ambulatory blood pressure monitoring for risk stratification in obese and non-obese subjects from 10 populations.
abstract: Overweight clusters with high blood pressure (BP), but the independent contribution of both risk factors remains insufficiently documented. In a prospective population study involving 8467 participants (mean age 54.6 years; 47.0% women) randomly recruited from 10 populations, we studied the contribution of body mass index (BMI) to risk over and beyond BP, taking advantage of the superiority of ambulatory over conventional BP. Over 10.6 years (median), 1271 participants (15.0%) died and 1092 (12.9%), 637 (7.5%) and 443 (5.2%) experienced a fatal or nonfatal cardiovascular, cardiac or cerebrovascular event. Adjusted for sex and age, low BMI (<20.7 kg m(-2)) predicted death (hazard ratio (HR) vs average risk, 1.52; P<0.0001) and high BMI (> or = 30.9 kg m(-2)) predicted the cardiovascular end point (HR, 1.27; P=0.006). With adjustments including 24-h systolic BP, these HRs were 1.50 (P<0.001) and 0.98 (P=0.91), respectively. Across quartiles of the BMI distribution, 24-h and nighttime systolic BP predicted every end point (1.13 < or = standardized HR < or = 1.67; 0.046 < or = P<0.0001). The interaction between systolic BP and BMI was nonsignificant (P > or = .22). Excluding smokers removed the contribution of BMI categories to the prediction of mortality. In conclusion, BMI only adds to BP in risk stratification for mortality but not for cardiovascular outcomes. Smoking probably explains the association between increased mortality and low BMI.
authors.affiliation: Steno Diabetes Centre, Gentofte and Research Centre for Prevention and Health, Glostrup, Denmark.
authors.forename: T W
authors.initials: TW
authors.lastname: Hansen
authors.affiliation: Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Thijs
authors.affiliation: 1] Center for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Jiantong University School of Medicine, Shanghai, China [2] Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiantong University School of Medicine, Shanghai, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Li
authors.affiliation: Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
authors.forename: J
authors.initials: J
authors.lastname: Boggia
authors.affiliation: Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
authors.forename: Y
authors.initials: Y
authors.lastname: Liu
authors.affiliation: 1] Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium [2] Tohoku University Graduate School of Pharmaceutical Science and Medicine, Sendai, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Asayama
authors.affiliation: Tohoku University Graduate School of Pharmaceutical Science and Medicine, Sendai, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Kikuya
authors.affiliation: Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Björklund-Bodegård
authors.affiliation: Department of Health Sciences, Shiga University of Medical Sciences, Otsu, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ohkubo
authors.affiliation: Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Jeppesen
authors.affiliation: Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: C
authors.identifier: 0000000328926131
authors.initials: C
authors.lastname: Torp-Pedersen
authors.affiliation: Addenbrook's Hospital, Cambridge University Hospitals, Cambridge, UK.
authors.forename: E
authors.initials: E
authors.lastname: Dolan
authors.affiliation: Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
authors.forename: T
authors.initials: T
authors.lastname: Kuznetsova
authors.affiliation: First Department of Cardiology and Hypertension, Jagiellonian University Medical College, Kra-ków, Poland.
authors.forename: K
authors.initials: K
authors.lastname: Stolarz-Skrzypek
authors.affiliation: Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Tikhonoff
authors.affiliation: Institute of Internal Medicine, Novosibirsk, Russian Federation.
authors.forename: S
authors.initials: S
authors.lastname: Malyutina
authors.affiliation: Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Casiglia
authors.affiliation: Institute of Internal Medicine, Novosibirsk, Russian Federation.
authors.forename: Y
authors.initials: Y
authors.lastname: Nikitin
authors.affiliation: Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Lind
authors.affiliation: The Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay.
authors.forename: E
authors.initials: E
authors.lastname: Sandoya
authors.affiliation: First Department of Cardiology and Hypertension, Jagiellonian University Medical College, Kra-ków, Poland.
authors.forename: K
authors.initials: K
authors.lastname: Kawecka-Jaszcz
authors.affiliation: Faculty of Medicine, Charles University, Pilsen, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Filipovský
authors.affiliation: Tohoku University Graduate School of Pharmaceutical Science and Medicine, Sendai, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Imai
authors.affiliation: Center for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Jiantong University School of Medicine, Shanghai, China.
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.affiliation: The Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland.
authors.forename: E
authors.initials: E
authors.lastname: O'Brien
authors.affiliation: 1] Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium [2] The Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
authors.forename: J A
authors.initials: JA
authors.lastname: Staessen
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001208:Asia / Q000453:epidemiology; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D015992:Body Mass Index; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis* / Q000188:drug therapy / Q000208:ethnology* / Q000401:mortality / Q000503:physiopathology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis* / Q000208:ethnology* / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000401:mortality; D013020:South America / Q000453:epidemiology; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents