title: 24-h pulse pressure cutoff point definition by office pulse pressure in a population of Spanish older hypertensive patients.
abstract: The European Guidelines on Hypertension define an office pulse pressure (PP) at least 60 mmHg in the elderly patient as asymptomatic organ damage. Our objective was to estimate the cutoff point of 24-h PP that best predicts office PP associated with higher cardiovascular risk (≥60 mmHg) in hypertensive older patients.
  
  
  
  We studied all hypertensive patients at least 60 years with a first valid ambulatory blood pressure monitoring drawn from the Spanish ambulatory blood pressure monitoring registry. Receiver operating characteristic curves were used to estimate the best 24-h PP cutoff predictor of office PP at least 60 mmHg that maximized the sum of sensitivity and specificity.
  
  
  
  We included 52 246 hypertensive patients [52.4%, female; mean age (SD) 69.0 (7.0) years]. From these, 34 530 (66.1%) patients had an office PP at least 60 mmHg. The value of 24-h PP that best predicts higher risk clinic PP is 54.9 mmHg [sensitivity: 69.2%; specificity: 70.3%; area under the receiver operating characteristic curve of 0.761 (95% confidence interval 0.756-0.765)]. Mean clinic and 24-h PPs were progressively higher as the study participants were classified at higher cardiovascular risk group. Some 20.5% of patients presented isolated office high PP and 10% a masked high 24-h PP.
  
  
  
  In a large clinical sample of older hypertensive patients, the cutoff point of 24-h PP that best predicts office PP at least 60 mmHg is 55 mmHg. In 30.5% of cases, there is a discrepancy between office PP and ambulatory 24-h PP.
authors.affiliation: aLa Mina Primary Care Center. University of Barcelona bHypertension Unit, Hospital Mútua de Terrassa, University of Barcelona, Barcelona cJordi Gol Institute for Research in Primary Care, Universitat Autònoma de Barcelona, Bellaterra dDepartment of Preventive Medicine and Public Health, CIBER in Epidemiology and Public Health, Universidad Autónoma de Madrid/IdiPAZ, Madrid eNephrology Service, Hospital Universitario Central de Asturias, Oviedo fHypertension Unit and Cardiorenal Translational Laboratory, Institute of Research i+12, Hospital Universitario 12 de Octubre. Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid. School of Doctoral Studies and Research. Universidad Europea de Madrid, Madrid gCasas Ibáñez Primary Care Center, Universidad Católica San Antonio, Murcia, Spain.
authors.forename: Ernest
authors.initials: E
authors.lastname: Vinyoles
authors.forename: Alejandro
authors.initials: A
authors.lastname: de la Sierra
authors.forename: Albert
authors.initials: A
authors.lastname: Roso-Llorach
authors.forename: José R
authors.initials: JR
authors.lastname: Banegas
authors.forename: Juan José
authors.initials: JJ
authors.lastname: de la Cruz
authors.forename: Manuel
authors.initials: M
authors.lastname: Gorostidi
authors.forename: Julián
authors.initials: J
authors.lastname: Segura
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Divisón
authors.forename: Gema
authors.initials: G
authors.lastname: Ruíz-Hurtado
authors.forename: Luis Miguel
authors.initials: LM
authors.lastname: Ruilope
mesh_terms: D000368:Aged; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000379:methods*; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012307:Risk Factors; D013030:Spain