Thresholds for Conventional and Home Blood Pressure by Sex and Age in 5018 Participants From 5 Populations
Open accessAbstract
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.
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Outcome studies in Japan, Greece and Finland with somewhat different HBPM protocols, as well as the IDHOCO database, indicated that the prognostic value of HBPM for cardiovascular disease is increased within the range of 1-7 days, with most benefit achieved in the first 3-4 days.
“Outcome studies in Japan, Greece and Finland with somewhat different HBPM protocols, as well as of the IDHOCO database indicated that the prognostic value of HBPM for cardiovascular disease is increased within the range of 1–7 days, with most of this benefit achieved in the first 3–4 days [131,136–138]”
Morning day-by-day HBPV may have superior prognostic value compared with morning-evening or evening HBPV.
“Morning day-by-day HBPV may have superior prognostic value as compared with morning--evening or evening HBPV [137,251].”
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- Authors
- Nomura, K., Asayama, K., Thijs, L., Niiranen, T. J., Lujambio, I., Boggia, J., Hozawa, A., Ohkubo, T., Hara, A., Johansson, J. K., Sandoya, E., Kollias, A., Stergiou, G. S., Tsuji, I., Jula, A. M., Imai, Y., & Staessen, J. A.
- Affiliations
- National and Kapodistrian University of Athens (GR)
- 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,...
- ORCID
- Venue
- Hypertension
- Published
- 2014-10
- Volume
- 64
- Issue
- 4
- Pages
- 695-701
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2157762005
- Cited by
- 27
- References
- 30
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 4 · 2023: 3 · 2022: 2 · 2021: 1 · 2019: 2 · 2018: 1 · 2017: 4 · 2016: 4 · 2015: 3 · 2014: 1
- FWCI
- 2.76
- Type
- journal article
- Language
- en
- Open access
- Licence
- other-oa
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- Lirias (submittedVersion, other-oa)
- Institutional Repositories DataBase (IRDB) (submittedVersion, cc-by-nc-nd)
- STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion)
- Funders
- European Commission (LSHM-CT-2006-037093, 201550, IC15-CT98-0329-EPOGH, 278249, 305507)
- Työsuojelurahasto
- Daiwa Securities Health Foundation
- Suomen Hammaslääkäriliitto
- Vlaamse regering
- Japan Society for the Promotion of Science (23390171, 25253059)
- 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
- hypertension threshold, home blood pressure, sex differences, age differences, cardiovascular risk, untreated hypertensive patients, cardiovascular events, blood pressure guidelines
- MeSH terms
- Adult, Age Factors, Aged, Aged, 80 and over, Blood Pressure, Cardiovascular Diseases, Diastole, Female, Humans, Hypertension, Male, Middle Aged, Population Surveillance, Reference Values, Risk Factors, Sex Factors, Systole, Time Factors, Risk Assessment, Blood Pressure Monitoring, Ambulatory, Young Adult
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