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Hypertension. 2014 Oct;64(4):695-701. doi: 10.1161/HYPERTENSIONAHA.114.03839. Epub 2014 Jun 30.

Thresholds for conventional and home blood pressure by sex and age in 5018 participants from 5 populations.

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1
From the Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.N., K.A., T.O.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (K.A., L.T., A. Hara, J.A.S.); Graduate School of Pharmaceutical Sciences (K.A., Y.I.), Tohoku Medical Megabank Organization (A. Hozawa), and Graduate School of Medicine (I.T.), Tohoku University, Sendai, Japan; Population Studies Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland (T.J.N., J.K.J., A.M.J.); Department of Medicine, Turku University Hospital, Turku, Finland (T.J.N.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (I.L., J.B.); the Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay (E.S.); Hypertension Center, Third Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece (A.K., G.S.S.); and Department of Epidemiology, Maastricht University, Maastricht, The Netherlands (J.A.S.).
2
From the Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.N., K.A., T.O.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (K.A., L.T., A. Hara, J.A.S.); Graduate School of Pharmaceutical Sciences (K.A., Y.I.), Tohoku Medical Megabank Organization (A. Hozawa), and Graduate School of Medicine (I.T.), Tohoku University, Sendai, Japan; Population Studies Unit, Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland (T.J.N., J.K.J., A.M.J.); Department of Medicine, Turku University Hospital, Turku, Finland (T.J.N.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (I.L., J.B.); the Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay (E.S.); Hypertension Center, Third Department of Medicine, University of Athens, Sotiria Hospital, Athens, Greece (A.K., G.S.S.); and Department of Epidemiology, Maastricht University, Maastricht, The Netherlands (J.A.S.). jan.staessen@med.kuleuven.be.

Abstract

Whether blood pressure thresholds for hypertension should differ according to sex or age remains debated. We did a subject-level meta-analysis of 5018 people untreated for hypertension and randomly recruited from 5 populations (women, 56.7%; ≥60 years, 42.3%). We used multivariable-adjusted Cox regression and a bootstrap procedure to determine home blood pressure (HBP) levels yielding 10-year cardiovascular risks similar to those associated with established systolic/diastolic thresholds (140-160/80-100 mm Hg) for the conventional blood pressure (CBP). Conversely, we estimated CBP thresholds providing 10-year cardiovascular risks similar to those associated established HBP levels (125-135/80-85 mm Hg). All analyses were stratified for sex and age (<60 versus ≥60 years). During 8.3 years (median), 414 participants experienced a cardiovascular event. The sex differences between HBP thresholds derived from CBP and between CBP thresholds derived from HBP were all nonsignificant (P≥0.24), ranging from -4.6 to 3.6 mm Hg systolic and from -4.3 to 2.1 mm Hg diastolic. The age differences between HBP thresholds derived from CBP and between CBP thresholds derived from HBP ranged from -6.7 to 8.4 mm Hg systolic and from -1.9 to 1.7 mm Hg diastolic and were nonsignificant (P≥0.08), except for HBP thresholds derived from CBP levels of 140 mm Hg systolic and 80 mm Hg diastolic (P≤0.04). Sensitivity analyses based on cardiac or cerebrovascular complications were confirmatory. In conclusion, our findings based on outcome-driven criteria support contemporary guidelines that propose single blood pressure thresholds that can be indiscriminately applied in both sexes and across the age range.

KEYWORDS:

aged; classification; home blood pressure monitoring; population; self blood pressure monitoring; women

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