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

Jana Brguljan-Hitij, Lutgarde Thijs, Yan Li, Tine W. Hansen, Jose Boggia, Yan Ping Liu, Kei Asayama, Fang Fei Wei, Kristina Bjorklund-Bodegard, Yu Mei Gu, Takayoshi Ohkubo, Jorgen Jeppesen, Christian Torp-Pedersen, Eamon Dolan, Tatiana Kuznetsova, Stolarz Skrzypek Katarzyna, Valerie Tikhonoff, Sofia Malyutina, Edoardo Casiglia, Yuri NikitinLars Lind, Edgardo Sandoya, Kalina Kawecka-Jaszcz, Jan Filipovsky, Yutaka Imai, Jiguang Wang, Eoin O'Brien, Jan A. Staessen

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

BACKGROUND Guidelines propose classification of conventional blood pressure (CBP) into normotension (<120/<80mm Hg), prehypertension (120-139/80-89mm Hg), and hypertension (≥140/≥90mm 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 (+5mm 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 (+10mm 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/≥85mm 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.

Original languageEnglish
Pages (from-to)956-965
Number of pages10
JournalAmerican Journal of Hypertension
Volume27
Issue number7
DOIs
Publication statusPublished - 2014 Jul

Keywords

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

ASJC Scopus subject areas

  • Internal Medicine

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