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Outcome-Driven Thresholds for Ambulatory Blood Pressure Based on the New American College of Cardiology/American Heart Association Classification of Hypertension

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  • Yi-Bang Cheng
  • Lutgarde Thijs
  • Zhen-Yu Zhang
  • Masahiro Kikuya
  • Wen-Yi Yang
  • Jesus D Melgarejo
  • José Boggia
  • Fang-Fei Wei
  • Tine W Hansen
  • Cai-Guo Yu
  • Kei Asayama
  • Takayoshi Ohkubo
  • Eamon Dolan
  • Katarzyna Stolarz-Skrzypek
  • Sofia Malyutina
  • Edoardo Casiglia
  • Lars Lind
  • Jan Filipovský
  • Gladys E Maestre
  • Yutaka Imai
  • Kalina Kawecka-Jaszcz
  • Edgardo Sandoya
  • Krzysztof Narkiewicz
  • Yan Li
  • Eoin O'Brien
  • Ji-Guang Wang
  • Jan A Staessen
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The new American College of Cardiology/American Heart Association guideline reclassified office blood pressure and proposed thresholds for ambulatory blood pressure (ABP). We derived outcome-driven ABP thresholds corresponding with the new office blood pressure categories. We performed 24-hour ABP monitoring in 11 152 participants (48.9% women; mean age, 53.0 years) representative of 13 populations. We determined ABP thresholds resulting in multivariable-adjusted 10-year risks similar to those associated with elevated office blood pressure (120/80 mm Hg) and stages 1 and 2 of office hypertension (130/80 and 140/90 mm Hg). Over 13.9 years (median), 2728 (rate per 1000 person-years, 17.9) people died, 1033 (6.8) from cardiovascular disease; furthermore, 1988 (13.8), 893 (6.0), and 795 (5.4) cardiovascular and coronary events and strokes occurred. Using a composite cardiovascular end point, systolic/diastolic outcome-driven thresholds indicating elevated 24-hour, daytime, and nighttime ABP were 117.9/75.2, 121.4/79.6, and 105.3/66.2 mm Hg. For stages 1 and 2 ambulatory hypertension, thresholds were 123.3/75.2 and 128.7/80.7 mm Hg for 24-hour ABP, 128.5/79.6 and 135.6/87.1 mm Hg for daytime ABP, and 111.7/66.2 and 118.1/72.5 mm Hg for nighttime ABP. ABP thresholds derived from other end points were similar. After rounding, approximate thresholds for elevated 24-hour, daytime, and nighttime ABP were 120/75, 120/80, and 105/65 mm Hg, and for stages 1 and 2, ambulatory hypertension 125/75 and 130/80 mm Hg, 130/80 and 135/85 mm Hg, and 110/65 and 120/70 mm Hg. Outcome-driven ABP thresholds corresponding to elevated blood pressure and stages 1 and 2 of hypertension are similar to those proposed by the current American College of Cardiology/American Heart Association guideline.

Original languageEnglish
JournalHypertension
Volume74
Issue number4
Pages (from-to)776-783
Number of pages8
ISSN0194-911X
DOIs
Publication statusPublished - 1 Oct 2019

    Research areas

  • blood pressure monitoring, ambulatory, hypertension, United States

ID: 58014536