Ambulatory blood pressure monitoring in 9357 subjects from 11 populations highlights missed opportunities for cardiovascular prevention in women

José Boggia, Lutgarde Thijs, Tine W. Hansen, Yan Li, Masahiro Kikuya, Kristina Björklund-Bodegård, Tom Richart, Takayoshi Ohkubo, Jørgen Jeppesen, Christian Torp-Pedersen, Eamon Dolan, Tatiana Kuznetsova, Agnieszka Olszanecka, Valérie Tikhonoff, Sofia Malyutina, Edoardo Casiglia, Yuri Nikitin, Lars Lind, Gladys Maestre, Edgardo SandoyaKalina Kawecka-Jaszcz, Yutaka Imai, Jiguang Wang, Hans Ibsen, Eoin O'Brien, Jan A. Staessen

Research output: Contribution to journalArticlepeer-review

73 Citations (Scopus)

Abstract

To analyze sex-specific relative and absolute risks associated with blood pressure (BP), we performed conventional and 24-hour ambulatory BP measurements in 9357 subjects (mean age, 52.8 years; 47% women) recruited from 11 populations. We computed standardized multivariable-adjusted hazard ratios for associations between outcome and systolic BP. During a course of 11.2 years (median), 1245 participants died, 472 of cardiovascular causes. The number of fatal combined with nonfatal events was 1080, 525, and 458 for cardiovascular and cardiac events and for stroke, respectively. In women and men alike, systolic BP predicted outcome, irrespective of the type of BP measurement. Women compared with men were at lower risk (hazard ratios for death and all cardiovascular events=0.66 and 0.62, respectively; P<0.001). However, the relation of all cardiovascular events with 24-hour BP (P=0.020) and the relations of total mortality (P=0.023) and all cardiovascular (P=0.0013), cerebrovascular (P=0.045), and cardiac (P=0.034) events with nighttime BP were steeper in women than in men. Consequently, per a 1-SD decrease, the proportion of potentially preventable events was higher in women than in men for all cardiovascular events (35.9% vs 24.2%) in relation to 24-hour systolic BP (1-SD, 13.4 mm Hg) and for all-cause mortality (23.1% vs 12.3%) and cardiovascular (35.1% vs 19.4%), cerebrovascular (38.3% vs 25.9%), and cardiac (31.0% vs 16.0%) events in relation to systolic nighttime BP (1-SD, 14.1 mm Hg). In conclusion, although absolute risks associated with systolic BP were lower in women than men, our results reveal a vast and largely unused potential for cardiovascular prevention by BP-lowering treatment in women.

Original languageEnglish
Pages (from-to)397-405
Number of pages9
JournalHypertension
Volume57
Issue number3
DOIs
Publication statusPublished - 2011 Mar

Keywords

  • blood pressure
  • epidemiology
  • morbidity
  • risk factors
  • women

ASJC Scopus subject areas

  • Internal Medicine

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