Diagnostic Thresholds for Ambulatory Blood Pressure Monitoring Based on 10-Year Cardiovascular Risk
Open accessAbstract
Background— Current diagnostic thresholds for ambulatory blood pressure (ABP) mainly rely on statistical parameters derived from reference populations. We determined an outcome-driven reference frame for ABP measurement. Methods and Results— We performed 24-hour ABP monitoring in 5682 participants (mean age 59.0 years; 43.3% women) enrolled in prospective population studies in Copenhagen, Denmark; Noorderkempen, Belgium; Ohasama, Japan; and Uppsala, Sweden. In multivariate analyses, we determined ABP thresholds, which yielded 10-year cardiovascular risks similar to those associated with optimal (120/80 mm Hg), normal (130/85 mm Hg), and high (140/90 mm Hg) blood pressure on office measurement. Over 9.7 years (median), 814 cardiovascular end points occurred, including 377 strokes and 435 cardiac events. Systolic/diastolic thresholds for optimal ABP were 116.8/74.2 mm Hg for 24 hours, 121.6/78.9 mm Hg for daytime, and 100.9/65.3 mm Hg for nighttime. Corresponding thresholds for normal ABP were 123.9/76.8, 129.9/82.6, and 110.2/68.1 mm Hg, respectively, and those for ambulatory hypertension were 131.0/79.4, 138.2/86.4, and 119.5/70.8 mm Hg. After rounding, approximate thresholds for optimal ABP amounted to 115/75 mm Hg for 24 hours, 120/80 mm Hg for daytime, and 100/65 mm Hg for nighttime. Rounded thresholds for normal ABP were 125/75, 130/85, and 110/70 mm Hg, respectively, and those for ambulatory hypertension were 130/80, 140/85, and 120/70 mm Hg. Conclusions— Population-based outcome-driven thresholds for optimal and normal ABP are lower than those currently proposed by hypertension guidelines.
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In untreated individuals aged older than 80 years, a significant increase in cardiovascular risk was observed for systolic HBP at least 152.4 mmHg and no risk increase was associated with increased diastolic HBP.
“Conversely, in untreated individuals aged older than 80 years, a significant increase in cardiovascular risk was observed for systolic HBP at least 152.4 mmHg and no risk increase was associated with increased diastolic HBP (the risk level was highest for lowest DBP levels) [142]”
In the very elderly, the BP-related risk increase may begin at higher HBP levels.
“In the very elderly, the BP-related risk increase may begin at higher HBP levels but more evidence is needed”
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- Authors
- Kikuya, M., Hansen, T. W., Thijs, L., Björklund-Bodegård, K., Kuznetsova, T., Ohkubo, T., Richart, T., Torp-Pedersen, C., Lind, L., Ibsen, H., Imai, Y., & Staessen, J. A.
- Affiliations
- Uppsala University (SE)
- From the Tohoku University Graduate School of Pharmaceutical Science and Medicine, Sendai, Japan (M.K., T.O., Y.I.); the Research Center for Prevention and Health, Copenhagen, Denmark (T.W.H.); the Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium (M.K., L.T., T.K., T.R., J.A.S.); the Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala,...
- ORCID
- Venue
- Circulation
- Published
- 2007-04-24
- Volume
- 115
- Issue
- 16
- Pages
- 2145-2152
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W1992145371
- Cited by
- 314
- References
- 34
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 14 · 2023: 9 · 2022: 4 · 2021: 4 · 2020: 13 · 2019: 17 · 2018: 17 · 2017: 22 · 2016: 15 · 2015: 12 · 2014: 24 · 2013: 25 · 2012: 25
- FWCI
- 19.96
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Lirias (acceptedVersion, other-oa)
- Funders
- Hjerteforeningen
- European Commission
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- ambulatory blood pressure monitoring, diagnostic thresholds, cardiovascular risk, hypertension, optimal blood pressure, normotension, ambulatory hypertension, 24-hour ambulatory blood pressure, stroke, cardiovascular events
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Alcohol Drinking, Antihypertensive Agents, Auscultation, Belgium, Cardiovascular Diseases, Circadian Rhythm, Coronary Disease, Denmark, Diabetes Mellitus, Female, Heart Failure, Humans, Hypertension, Japan, Male, Middle Aged, Myocardial Revascularization, Oscillometry, Predictive Value of Tests, Prospective Studies, Reference Values, Risk Factors, Smoking, Sweden, Reproducibility of Results, Cohort Studies, Confounding Factors, Epidemiologic, Body Mass Index, Proportional Hazards Models, Death, Sudden, Cardiac, Myocardial Ischemia, Blood Pressure Monitoring, Ambulatory, Sphygmomanometers, Stroke, Dyslipidemias
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