Blood pressure load does not add to ambulatory blood pressure level for cardiovascular risk stratification

Yan Li, Lutgarde Thijs, José Boggia, Kei Asayama, Tine W. Hansen, Masahiro Kikuya, Kristina Björklund-Bodegård, Takayoshi Ohkubo, Jørgen Jeppesen, Christian Torp-Pedersen, Eamon Dolan, Tatiana Kuznetsova, Katarzyna Stolarz-Skrzypek, Valérie Tikhonoff, Sofia Malyutina, Edoardo Casiglia, Yuri Nikitin, Lars Lind, Edgardo Sandoya, Kalina Kawecka-JaszczJan Filipovský, Yutaka Imai, Hans Ibsen, Eoin O'Brien, Jiguang Wang, Jan A. Staessen

Research output: Contribution to journalArticlepeer-review

22 Citations (Scopus)

Abstract

Experts proposed blood pressure (BP) load derived from 24-hour ambulatory BP recordings as a more accurate predictor of outcome than level, in particular in normotensive people. We analyzed 8711 subjects (mean age, 54.8 years; 47.0% women) randomly recruited from 10 populations. We expressed BP load as percentage (%) of systolic/diastolic readings ≥135/≥85 mm Hg and ≥120/≥70 mm Hg during day and night, respectively, or as the area under the BP curve (mm Hg×h) using the same ceiling values. During a period of 10.7 years (median), 1284 participants died and 1109 experienced a fatal or nonfatal cardiovascular end point. In multivariable-adjusted models, the risk of cardiovascular complications gradually increased across deciles of BP level and load (P<0.001), but BP load did not substantially refine risk prediction based on 24-hour systolic or diastolic BP level (generalized R2 statistic ≤0.294%; net reclassification improvement ≤0.28%; integrated discrimination improvement ≤0.001%). Systolic/diastolic BP load of 40.0/42.3% or 91.8/73.6 mm Hg×h conferred a 10-year risk of a composite cardiovascular end point similar to a 24-hour systolic/diastolic BP of 130/80 mm Hg. In analyses dichotomized according to these thresholds, increased BP load did not refine risk prediction in the whole study population (R 2<0.051) or in untreated participants with 24-hour ambulatory normotension (R2<0.034). In conclusion, BP load does not improve risk stratification based on 24-hour BP level. This also applies to subjects with normal 24-hour BP for whom BP load was proposed to be particularly useful in risk stratification.

Original languageEnglish
Pages (from-to)925-933
Number of pages9
JournalHypertension
Volume63
Issue number5
DOIs
Publication statusPublished - 2014 May

Keywords

  • Ambulatory blood pressure monitoring
  • Epidemiology
  • Risk factors

ASJC Scopus subject areas

  • Internal Medicine

Fingerprint Dive into the research topics of 'Blood pressure load does not add to ambulatory blood pressure level for cardiovascular risk stratification'. Together they form a unique fingerprint.

Cite this