Defining thresholds for home blood pressure monitoring in octogenarians.
To generate outcome-driven thresholds for home blood pressure (BP) in the elderly, we analyzed 375 octogenarians (60.3% women; 83.0 years [mean]) enrolled in the International Database on home BP in relation to cardiovascular outcome. Over 5.5 years (median), 155 participants died, 76 from cardiovascular causes, whereas 104, 55, 36, and 51 experienced a cardiovascular, cardiac, coronary, or cerebrovascular event, respectively. In 202 untreated participants, home diastolic in the lowest fifth of the distribution (≤65.1 mm Hg) compared with the multivariable-adjusted average risk was associated with increased risk of cardiovascular mortality and morbidity (hazard ratios [HRs], ≥1.96; P≤0.022), whereas the HR for cardiovascular mortality in the top fifth (≥82.0 mm Hg) was 0.37 (P=0.034). Among 173 participants treated for hypertension, the HR for total mortality in the lowest fifth of systolic home BP (<126.9 mm Hg) was 2.09 (P=0.020). In further analyses of home BP as continuous variable (per 1-SD increment), higher diastolic BP predicted lower cardiovascular mortality and morbidity and cardiac and coronary risk (HR≤0.65; P≤0.039) in untreated participants. In those treated, cardiovascular morbidity was curvilinearly associated with systolic home BP with nadir at 148.6 mm Hg and with a 1.45 HR (P=0.046) for a 1-SD decrease below this threshold. In conclusion, in untreated octogenarians, systolic home BP ≥152.4 and diastolic BP ≤65.1 mm Hg entails increased cardiovascular risk, whereas diastolic home BP ≥82 mm Hg minimizes risk. In those treated, systolic home BP <126.9 mm Hg was associated with increased total mortality with lowest risk at 148.6 mm Hg.
From the Division of Hypertension, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Capital Federal, Argentina (L.S.A., Jessica Barochiner, J.A., P.E.C., G.D.W.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., L.J., A.N.O., J.A.S.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (José Boggia); Department of Internal Medicine, College of Health Sciences, University of Abuja, Abuja, Nigeria (A.N.O.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., K.N., T.O.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center, Third Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece (G.S.S); Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (M.K., Y.I.); and R & D VitaK Group, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Lucas S
LS
Aparicio
From the Division of Hypertension, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Capital Federal, Argentina (L.S.A., Jessica Barochiner, J.A., P.E.C., G.D.W.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., L.J., A.N.O., J.A.S.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (José Boggia); Department of Internal Medicine, College of Health Sciences, University of Abuja, Abuja, Nigeria (A.N.O.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., K.N., T.O.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center, Third Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece (G.S.S); Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (M.K., Y.I.); and R & D VitaK Group, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Lutgarde
L
Thijs
From the Division of Hypertension, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Capital Federal, Argentina (L.S.A., Jessica Barochiner, J.A., P.E.C., G.D.W.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., L.J., A.N.O., J.A.S.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (José Boggia); Department of Internal Medicine, College of Health Sciences, University of Abuja, Abuja, Nigeria (A.N.O.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., K.N., T.O.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center, Third Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece (G.S.S); Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (M.K., Y.I.); and R & D VitaK Group, Maastricht University, Maastricht, The Netherlands (J.A.S.).
José
J
Boggia
From the Division of Hypertension, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Capital Federal, Argentina (L.S.A., Jessica Barochiner, J.A., P.E.C., G.D.W.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., L.J., A.N.O., J.A.S.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (José Boggia); Department of Internal Medicine, College of Health Sciences, University of Abuja, Abuja, Nigeria (A.N.O.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., K.N., T.O.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center, Third Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece (G.S.S); Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (M.K., Y.I.); and R & D VitaK Group, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Lotte
L
Jacobs
From the Division of Hypertension, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Capital Federal, Argentina (L.S.A., Jessica Barochiner, J.A., P.E.C., G.D.W.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., L.J., A.N.O., J.A.S.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (José Boggia); Department of Internal Medicine, College of Health Sciences, University of Abuja, Abuja, Nigeria (A.N.O.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., K.N., T.O.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center, Third Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece (G.S.S); Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (M.K., Y.I.); and R & D VitaK Group, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Jessica
J
Barochiner
From the Division of Hypertension, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Capital Federal, Argentina (L.S.A., Jessica Barochiner, J.A., P.E.C., G.D.W.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., L.J., A.N.O., J.A.S.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (José Boggia); Department of Internal Medicine, College of Health Sciences, University of Abuja, Abuja, Nigeria (A.N.O.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., K.N., T.O.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center, Third Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece (G.S.S); Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (M.K., Y.I.); and R & D VitaK Group, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Augustine N
AN
Odili
From the Division of Hypertension, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Capital Federal, Argentina (L.S.A., Jessica Barochiner, J.A., P.E.C., G.D.W.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., L.J., A.N.O., J.A.S.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (José Boggia); Department of Internal Medicine, College of Health Sciences, University of Abuja, Abuja, Nigeria (A.N.O.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., K.N., T.O.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center, Third Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece (G.S.S); Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (M.K., Y.I.); and R & D VitaK Group, Maastricht University, Maastricht, The Netherlands (J.A.S.).
José
J
Alfie
From the Division of Hypertension, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Capital Federal, Argentina (L.S.A., Jessica Barochiner, J.A., P.E.C., G.D.W.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., L.J., A.N.O., J.A.S.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (José Boggia); Department of Internal Medicine, College of Health Sciences, University of Abuja, Abuja, Nigeria (A.N.O.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., K.N., T.O.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center, Third Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece (G.S.S); Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (M.K., Y.I.); and R & D VitaK Group, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Kei
K
Asayama
From the Division of Hypertension, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Capital Federal, Argentina (L.S.A., Jessica Barochiner, J.A., P.E.C., G.D.W.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., L.J., A.N.O., J.A.S.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (José Boggia); Department of Internal Medicine, College of Health Sciences, University of Abuja, Abuja, Nigeria (A.N.O.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., K.N., T.O.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center, Third Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece (G.S.S); Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (M.K., Y.I.); and R & D VitaK Group, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Paula E
PE
Cuffaro
From the Division of Hypertension, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Capital Federal, Argentina (L.S.A., Jessica Barochiner, J.A., P.E.C., G.D.W.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., L.J., A.N.O., J.A.S.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (José Boggia); Department of Internal Medicine, College of Health Sciences, University of Abuja, Abuja, Nigeria (A.N.O.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., K.N., T.O.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center, Third Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece (G.S.S); Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (M.K., Y.I.); and R & D VitaK Group, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Kyoko
K
Nomura
From the Division of Hypertension, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Capital Federal, Argentina (L.S.A., Jessica Barochiner, J.A., P.E.C., G.D.W.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., L.J., A.N.O., J.A.S.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (José Boggia); Department of Internal Medicine, College of Health Sciences, University of Abuja, Abuja, Nigeria (A.N.O.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., K.N., T.O.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center, Third Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece (G.S.S); Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (M.K., Y.I.); and R & D VitaK Group, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Takayoshi
T
Ohkubo
From the Division of Hypertension, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Capital Federal, Argentina (L.S.A., Jessica Barochiner, J.A., P.E.C., G.D.W.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., L.J., A.N.O., J.A.S.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (José Boggia); Department of Internal Medicine, College of Health Sciences, University of Abuja, Abuja, Nigeria (A.N.O.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., K.N., T.O.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center, Third Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece (G.S.S); Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (M.K., Y.I.); and R & D VitaK Group, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Ichiro
I
Tsuji
From the Division of Hypertension, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Capital Federal, Argentina (L.S.A., Jessica Barochiner, J.A., P.E.C., G.D.W.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., L.J., A.N.O., J.A.S.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (José Boggia); Department of Internal Medicine, College of Health Sciences, University of Abuja, Abuja, Nigeria (A.N.O.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., K.N., T.O.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center, Third Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece (G.S.S); Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (M.K., Y.I.); and R & D VitaK Group, Maastricht University, Maastricht, The Netherlands (J.A.S.).
George S
GS
Stergiou
From the Division of Hypertension, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Capital Federal, Argentina (L.S.A., Jessica Barochiner, J.A., P.E.C., G.D.W.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., L.J., A.N.O., J.A.S.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (José Boggia); Department of Internal Medicine, College of Health Sciences, University of Abuja, Abuja, Nigeria (A.N.O.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., K.N., T.O.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center, Third Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece (G.S.S); Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (M.K., Y.I.); and R & D VitaK Group, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Masahiro
M
Kikuya
From the Division of Hypertension, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Capital Federal, Argentina (L.S.A., Jessica Barochiner, J.A., P.E.C., G.D.W.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., L.J., A.N.O., J.A.S.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (José Boggia); Department of Internal Medicine, College of Health Sciences, University of Abuja, Abuja, Nigeria (A.N.O.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., K.N., T.O.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center, Third Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece (G.S.S); Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (M.K., Y.I.); and R & D VitaK Group, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Yutaka
Y
Imai
From the Division of Hypertension, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Capital Federal, Argentina (L.S.A., Jessica Barochiner, J.A., P.E.C., G.D.W.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., L.J., A.N.O., J.A.S.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (José Boggia); Department of Internal Medicine, College of Health Sciences, University of Abuja, Abuja, Nigeria (A.N.O.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., K.N., T.O.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center, Third Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece (G.S.S); Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (M.K., Y.I.); and R & D VitaK Group, Maastricht University, Maastricht, The Netherlands (J.A.S.).
Gabriel D
GD
Waisman
From the Division of Hypertension, Department of Internal Medicine, Hospital Italiano de Buenos Aires, Capital Federal, Argentina (L.S.A., Jessica Barochiner, J.A., P.E.C., G.D.W.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., L.J., A.N.O., J.A.S.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (José Boggia); Department of Internal Medicine, College of Health Sciences, University of Abuja, Abuja, Nigeria (A.N.O.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., K.N., T.O.); Department of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan (I.T.); Hypertension Center, Third Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece (G.S.S); Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (M.K., Y.I.); and R & D VitaK Group, Maastricht University, Maastricht, The Netherlands (J.A.S.). jan.staessen@med.kuleuven.be.
Jan A
JA
Staessen
D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D015994:Incidence; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors
aged; aged 80 and over; blood pressure monitoring; cardiovascular diseases; home; hypertension