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Am J Hypertens. 2014 Jul;27(7):956-65. doi: 10.1093/ajh/hpu002. Epub 2014 Feb 26.

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

Author information

1
Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium Department of Internal Medicine, Division of Hypertension, University Medical Centre Ljubljana, Slovenia.
2
Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium.
3
Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
4
Steno Diabetes Center, Gentofte and Research Centre for Prevention and Health, Gentofte, Denmark.
5
Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
6
Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan.
7
Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
8
Department of Cardiology, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
9
Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
10
Department of Medicine, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
11
Copenhagen University Hospital, Copenhagen, Denmark.
12
Cambridge University Hospitals, Addenbrook's Hospital, Cambridge, United Kingdom.
13
First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland.
14
Department of Medicine, University of Padua, Padua, Italy.
15
Institute of Internal Medicine, Novosibirsk, Russian Federation.
16
Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
17
Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay.
18
Faculty of Medicine, Charles University, Pilsen, Czech Republic.
19
Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan.
20
Center for Epidemiological Studies and Clinical Trials and.
21
Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland.
22
Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium Department of Epidemiology, Maastricht University, Maastricht, Netherlands jan.staessen@med.kuleuven.be.

Abstract

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.

KEYWORDS:

ambulatory blood pressure monitoring; blood pressure; hypertension; masked hypertension; population science; prehypertension; risk stratification

PMID:
24572704
DOI:
10.1093/ajh/hpu002
[Indexed for MEDLINE]

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