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Blood Press Monit. 2007 Dec;12(6):393-5. doi: 10.1097/MBP.0b013e3282f2b53d.

Diagnostic thresholds for ambulatory blood pressure monitoring based on 10-year cardiovascular risk.

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1
The Tohoku University Graduate School of Pharmaceutical Science and Medicine, Sendai, Japan.

Abstract

Current diagnostic thresholds for ambulatory blood pressure (ABP) mainly rely on statistical parameters derived from reference populations. We determined an outcome-driven reference frame for ABP measurement. We performed 24-h ABP monitoring in 5682 participants (mean age 59.0 years; 43.3% women) enrolled in prospective population studies in Copenhagen, Denmark; Noorderkempen, Belgium; Ohasama, Japan; and Uppsala, Sweden. In multivariate analyses, we determined ABP thresholds, which yielded 10-year cardiovascular risks similar to those associated with optimal (120/80 mmHg), normal (130/85 mmHg), and high (140/90 mmHg) blood pressure on office measurement. Over 9.7 years (median), 814 cardiovascular end points occurred, including 377 strokes and 435 cardiac events. Systolic/diastolic thresholds for optimal ABP were 118.3/74.2 mmHg for 24 h, 121.6/78.9 mmHg for daytime, and 104.7/65.3 mmHg for nighttime. Corresponding thresholds for normal ABP were 124.3/76.8, 129.9/82.6, and 111.6/68.1 mmHg, respectively, and those for ambulatory hypertension were 130.3/79.4, 138.2/86.4, and 118.5/70.8 mmHg. After rounding, approximate thresholds for optimal ABP amounted to 115/75 mmHg for 24 h, 120/80 mmHg for daytime, and 105/65 mmHg for nighttime. Rounded thresholds for normal ABP were 125/75, 130/85, and 110/70 mmHg, respectively, and those for ambulatory hypertension were 130/80, 140/85, and 120/70 mmHg. In conclusion, population-based outcome-driven thresholds for optimal and normal ABP are lower than those currently proposed by hypertension guidelines.

PMID:
18277319
DOI:
10.1097/MBP.0b013e3282f2b53d
[Indexed for MEDLINE]
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