title: Risk stratification by ambulatory blood pressure monitoring across JNC classes of conventional blood pressure.
abstract: BACKGROUND
  Guidelines propose classification of conventional blood pressure (CBP) into normotension (<120/<80 mm Hg), prehypertension (120-139/80-89 mm Hg), and hypertension (≥140/≥90 mm Hg).
  
  
  METHODS
  To assess the potential differential contribution of ambulatory blood pressure (ABP) in predicting risk across CBP strata, we analyzed outcomes in 7,826 untreated people recruited from 11 populations.
  
  
  RESULTS
  During an 11.3-year period, 809 participants died (276 cardiovascular deaths) and 639, 383, and 225 experienced a cardiovascular, cardiac, or cerebrovascular event. Compared with normotension (n = 2,639), prehypertension (n = 3,076) carried higher risk (P ≤ 0.015) of cardiovascular (+41%) and cerebrovascular (+92%) endpoints; compared with hypertension (n = 2,111) prehypertension entailed lower risk (P ≤ 0.005) of total mortality (-14%) and cardiovascular mortality (-29%) and of cardiovascular (-34%), cardiac (-33%), or cerebrovascular (-47%) events. Multivariable-adjusted hazard ratios (HRs) for stroke associated with 24-hour and daytime diastolic ABP (+5 mm Hg) were higher (P ≤ 0.045) in normotension than in prehypertension and hypertension (1.98 vs.1.19 vs.1.28 and 1.73 vs.1.09 vs. 1.24, respectively) with similar trends (0.03 ≤ P ≤ 0.11) for systolic ABP (+10 mm Hg). However, HRs for fatal endpoints and cardiac events associated with ABP did not differ significantly (P ≥ 0.13) across CBP categories. Of normotensive and prehypertensive participants, 7.5% and 29.3% had masked hypertension (daytime ABP ≥135/≥85 mm Hg). Compared with true normotension (P ≤ 0.01), HRs for stroke were 3.02 in normotension and 2.97 in prehypertension associated with masked hypertension with no difference between the latter two conditions (P = 0.93).
  
  
  CONCLUSIONS
  ABP refines risk stratification in normotension and prehypertension mainly by enabling the diagnosis of masked hypertension.
authors.affiliation: Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium Department of Internal Medicine, Division of Hypertension, University Medical Centre Ljubljana, Slovenia.
authors.forename: Jana
authors.initials: J
authors.lastname: Brguljan-Hitij
authors.affiliation: Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium.
authors.forename: Lutgarde
authors.initials: L
authors.lastname: Thijs
authors.affiliation: Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Steno Diabetes Center, Gentofte and Research Centre for Prevention and Health, Gentofte, Denmark.
authors.forename: Tine W
authors.initials: TW
authors.lastname: Hansen
authors.affiliation: Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
authors.forename: Jose
authors.initials: J
authors.lastname: Boggia
authors.affiliation: Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium.
authors.forename: Yan-Ping
authors.initials: YP
authors.lastname: Liu
authors.affiliation: Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Asayama
authors.affiliation: Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Fang-Fei
authors.initials: FF
authors.lastname: Wei
authors.affiliation: Department of Cardiology, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Bjorklund-Bodegard
authors.affiliation: Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium.
authors.forename: Yu-Mei
authors.initials: YM
authors.lastname: Gu
authors.affiliation: Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
authors.affiliation: Department of Medicine, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jorgen
authors.initials: J
authors.lastname: Jeppesen
authors.affiliation: Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.affiliation: Cambridge University Hospitals, Addenbrook's Hospital, Cambridge, United Kingdom.
authors.forename: Eamon
authors.initials: E
authors.lastname: Dolan
authors.affiliation: Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Kuznetsova
authors.affiliation: First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland.
authors.forename: Stolarz-Skrzypek
authors.initials: SS
authors.lastname: Katarzyna
authors.affiliation: Department of Medicine, University of Padua, Padua, Italy.
authors.forename: Valerie
authors.initials: V
authors.lastname: Tikhonoff
authors.affiliation: Institute of Internal Medicine, Novosibirsk, Russian Federation.
authors.forename: Sofia
authors.initials: S
authors.lastname: Malyutina
authors.affiliation: Department of Medicine, University of Padua, Padua, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Casiglia
authors.affiliation: Institute of Internal Medicine, Novosibirsk, Russian Federation.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Nikitin
authors.affiliation: Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Lind
authors.affiliation: Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay.
authors.forename: Edgardo
authors.initials: E
authors.lastname: Sandoya
authors.affiliation: First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland.
authors.forename: Kalina
authors.initials: K
authors.lastname: Kawecka-Jaszcz
authors.affiliation: Faculty of Medicine, Charles University, Pilsen, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Filipovsky
authors.affiliation: Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Imai
authors.affiliation: Center for Epidemiological Studies and Clinical Trials and.
authors.forename: Jiguang
authors.initials: J
authors.lastname: Wang
authors.affiliation: Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland.
authors.forename: Eoin
authors.initials: E
authors.lastname: O'Brien
authors.affiliation: Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium Department of Epidemiology, Maastricht University, Maastricht, Netherlands jan.staessen@med.kuleuven.be.
authors.forename: Jan A
authors.initials: JA
authors.lastname: Staessen
mesh_terms: D000328:Adult; D001208:Asia / Q000453:epidemiology; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D059468:Masked Hypertension / Q000175:diagnosis / Q000503:physiopathology; D008875:Middle Aged; D058246:Prehypertension / Q000503:physiopathology; D012306:Risk; D013020:South America / Q000453:epidemiology; D020521:Stroke / Q000209:etiology
keywords: ambulatory blood pressure monitoring; blood pressure; hypertension; masked hypertension; population science; prehypertension; risk stratification