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Bispebjerg Hospital - en del af Københavns Universitetshospital

Risk stratification by ambulatory blood pressure monitoring across JNC classes of conventional blood pressure

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  • Jana Brguljan-Hitij
  • Lutgarde Thijs
  • Yan Li
  • Tine W Hansen
  • Jose Boggia
  • Yan-Ping Liu
  • Kei Asayama
  • Fang-Fei Wei
  • Kristina Bjorklund-Bodegard
  • Yu-Mei Gu
  • Takayoshi Ohkubo
  • Jorgen Jeppesen
  • Christian Torp-Pedersen
  • Eamon Dolan
  • Tatiana Kuznetsova
  • Stolarz-Skrzypek Katarzyna
  • Valerie Tikhonoff
  • Sofia Malyutina
  • Edoardo Casiglia
  • Yuri Nikitin
  • Lars Lind
  • Edgardo Sandoya
  • Kalina Kawecka-Jaszcz
  • Jan Filipovsky
  • Yutaka Imai
  • Jiguang Wang
  • Eoin O'Brien
  • Jan A Staessen
  • International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcome Investigators
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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).

CONCLUSION: ABP refines risk stratification in normotension and prehypertension mainly by enabling the diagnosis of masked hypertension.

TidsskriftAmerican Journal of Hypertension
Udgave nummer7
Sider (fra-til)956-65
Antal sider10
StatusUdgivet - jul. 2014

ID: 45024925