title: Cardiovascular Risk in Hypertension in Relation to Achieved Blood Pressure Using Automated Office Blood Pressure Measurement.
abstract: The SPRINT (Systolic Blood Pressure Intervention Trial) reported that some older, higher risk patients might benefit from a target systolic blood pressure (BP) of <120 versus <140 mm Hg. However, it is not yet known how the BP target and measurement methods used in SPRINT relate to cardiovascular outcomes in real-world practice. SPRINT used the automated office BP technique, which requires the patient to be resting quietly and alone, with multiple readings being recorded automatically using an electronic oscillometric sphygmomanometer. We studied the relationship between achieved automated office BP at baseline and cardiovascular events in 6183 community-dwelling residents of Ontario aged ≥66 years who were receiving antihypertensive therapy and followed for a mean of 4.6 years. Adjusted hazard ratios (95% confidence intervals) were computed for 10 mm Hg increments in achieved automated office BP at baseline using Cox proportional hazards regression and the BP category with the lowest event rate as the reference category. Based on 904 fatal and nonfatal cardiovascular events, the nadir of cardiovascular events was at the systolic pressure category of 110 to 119 mm Hg, which was lower than the next highest category of 120 to 129 mm Hg (hazard ratio 1.30 [1.01, 1.66]). The hazard ratio for diastolic pressure was relatively unchanged above 60 mm Hg. Pulse pressure exhibited an increase in hazard ratio (1.33 [1.02, 1.72]) at ≥80 mm Hg. These results using automated office BP measurement in a usual treatment setting extend the finding in SPRINT of an optimum target systolic BP of <120 mm Hg to routine clinical practice.
authors.affiliation: From the Schulich Heart Program, Sunnybrook Health Sciences Centre (M.G.M.), Institute for Clinical Evaluative Sciences (K.T., J.M.P.), University Health Network-Toronto Western Hospital Family Health Team (K.T.), Department of Medicine (M.G.M.), Department of Family and Community Medicine (K.T.), and Institute of Health Policy, Management and Evaluation (K.T., J.M.P.), University of Toronto, Toronto, Canada; the Department of Family and Emergency Medicine, Université de Montréal, and CRCHUM, Montreal, Canada (J.K.); the Department of Family Medicine, McMaster University, Hamilton, Canada (J.K., L.D., J.M.P.). martin.myers@sunnybrook.ca.
authors.forename: Martin G
authors.initials: MG
authors.lastname: Myers
authors.affiliation: From the Schulich Heart Program, Sunnybrook Health Sciences Centre (M.G.M.), Institute for Clinical Evaluative Sciences (K.T., J.M.P.), University Health Network-Toronto Western Hospital Family Health Team (K.T.), Department of Medicine (M.G.M.), Department of Family and Community Medicine (K.T.), and Institute of Health Policy, Management and Evaluation (K.T., J.M.P.), University of Toronto, Toronto, Canada; the Department of Family and Emergency Medicine, Université de Montréal, and CRCHUM, Montreal, Canada (J.K.); the Department of Family Medicine, McMaster University, Hamilton, Canada (J.K., L.D., J.M.P.).
authors.forename: Janusz
authors.initials: J
authors.lastname: Kaczorowski
authors.affiliation: From the Schulich Heart Program, Sunnybrook Health Sciences Centre (M.G.M.), Institute for Clinical Evaluative Sciences (K.T., J.M.P.), University Health Network-Toronto Western Hospital Family Health Team (K.T.), Department of Medicine (M.G.M.), Department of Family and Community Medicine (K.T.), and Institute of Health Policy, Management and Evaluation (K.T., J.M.P.), University of Toronto, Toronto, Canada; the Department of Family and Emergency Medicine, Université de Montréal, and CRCHUM, Montreal, Canada (J.K.); the Department of Family Medicine, McMaster University, Hamilton, Canada (J.K., L.D., J.M.P.).
authors.forename: Lisa
authors.initials: L
authors.lastname: Dolovich
authors.affiliation: From the Schulich Heart Program, Sunnybrook Health Sciences Centre (M.G.M.), Institute for Clinical Evaluative Sciences (K.T., J.M.P.), University Health Network-Toronto Western Hospital Family Health Team (K.T.), Department of Medicine (M.G.M.), Department of Family and Community Medicine (K.T.), and Institute of Health Policy, Management and Evaluation (K.T., J.M.P.), University of Toronto, Toronto, Canada; the Department of Family and Emergency Medicine, Université de Montréal, and CRCHUM, Montreal, Canada (J.K.); the Department of Family Medicine, McMaster University, Hamilton, Canada (J.K., L.D., J.M.P.).
authors.forename: Karen
authors.initials: K
authors.lastname: Tu
authors.affiliation: From the Schulich Heart Program, Sunnybrook Health Sciences Centre (M.G.M.), Institute for Clinical Evaluative Sciences (K.T., J.M.P.), University Health Network-Toronto Western Hospital Family Health Team (K.T.), Department of Medicine (M.G.M.), Department of Family and Community Medicine (K.T.), and Institute of Health Policy, Management and Evaluation (K.T., J.M.P.), University of Toronto, Toronto, Canada; the Department of Family and Emergency Medicine, Université de Montréal, and CRCHUM, Montreal, Canada (J.K.); the Department of Family Medicine, McMaster University, Hamilton, Canada (J.K., L.D., J.M.P.).
authors.forename: J Michael
authors.initials: JM
authors.lastname: Paterson
mesh_terms: D000367:Age Factors; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001331:Automation; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D016000:Cluster Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D057187:Independent Living; D008297:Male; D009864:Ontario; D016016:Proportional Hazards Models; D012015:Reference Standards; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013599:Systole / Q000187:drug effects
chemical_list: D000959:Antihypertensive Agents
keywords: antihypertensive therapy; automated blood pressure measurement; cardiovascular complications; cardiovascular risk; hypertension