Opposing Age-Related Trends in Absolute and Relative Risk of Adverse Health Outcomes Associated With Out-of-Office Blood Pressure

Li, Yan; Thijs, Lutgarde; Zhang, Zhen Yu; Asayama, Kei; Hansen, Tine W.; Boggia, José; Björklund-Bodegård, Kristina; Yang, Wen‐Yi; Niiranen, Teemu J.; Ntineri, Angeliki; Fang, Wei; Kikuya, Masahiro; Hozawa, Atsushi; Tsuji, Ichiro; Stolarz‐Skrzypek, Katarzyna; Huang, Qi; Melgarejo, Jesús D.; Tikhonoff, Valérie; Malyutina, Sofia; Casíglia, Edoardo; Nikitin, Yuri; Lind, Lars; Sandoya, Edgardo; Aparicio, Lucas S.; Barochiner, Jessica; Gilis‐Malinowska, Natasza; Kawecka‐Jaszcz, Kalina; Maestre, Gladys E.; Jula, Antti; Johansson, Jouni K.; Kuznetsova, Tatiana; Filipovský, Jan; Stergiou, George; Wang, Tzung‐Dau; Imai, Yutaka; O’Brien, Eoin; Staessen, Jan A.

doi:10.1161/hypertensionaha.119.12958

Cited by 35 publications

(35 citation statements)

References 42 publications

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“…The clinical relevance of our study pertains to the consideration of MAP for identifying hypertension and categorizing individuals according to their risk for adverse health outcomes. As reported before, 1 , 23 relative risk was higher at young than older age, whereas absolute followed the opposite trend (Table 3 ). Our observations have implications for hypertension management and the use and validation of oscillometric BP measuring devices.…”

Section: Discussionsupporting

confidence: 81%

Association of Fatal and Nonfatal Cardiovascular Outcomes With 24-Hour Mean Arterial Pressure

et al. 2021

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Major adverse cardiovascular events are closely associated with 24-hour blood pressure (BP). We determined outcome-driven thresholds for 24-hour mean arterial pressure (MAP), a BP index estimated by oscillometric devices. We assessed the association of major adverse cardiovascular events with 24-hour MAP, systolic BP (SBP), and diastolic BP (DBP) in a population-based cohort (n=11 596). Statistics included multivariable Cox regression and the generalized R 2 statistic to test model fit. Baseline office and 24-hour MAP averaged 97.4 and 90.4 mm Hg. Over 13.6 years (median), 2034 major adverse cardiovascular events occurred. Twenty-four-hour MAP levels of <90 (normotension, n=6183), 90 to <92 (elevated MAP, n=909), 92 to <96 (stage-1 hypertension, n=1544), and ≥96 (stage-2 hypertension, n=2960) mm Hg yielded equivalent 10-year major adverse cardiovascular events risks as office MAP categorized using 2017 American thresholds for office SBP and DBP. Compared with 24-hour MAP normotension, hazard ratios were 0.96 (95% CI, 0.80–1.16), 1.32 (1.15–1.51), and 1.77 (1.59–1.97), for elevated and stage-1 and stage-2 hypertensive MAP. On top of 24-hour MAP, higher 24-hour SBP increased, whereas higher 24-hour DBP attenuated risk ( P <0.001). Considering the 24-hour measurements, R 2 statistics were similar for SBP (1.34) and MAP (1.28), lower for DBP than for MAP (0.47), and reduced to null, if the base model included SBP and DBP; if the ambulatory BP indexes were dichotomized according to the 2017 American guideline and the proposed 92 mm Hg for MAP, the R 2 values were 0.71, 0.89, 0.32, and 0.10, respectively. In conclusion, the clinical application of 24-hour MAP thresholds in conjunction with SBP and DBP refines risk estimates.

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Section: Discussionsupporting

confidence: 81%

Association of Fatal and Nonfatal Cardiovascular Outcomes With 24-Hour Mean Arterial Pressure

et al. 2021

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“…The relation between cardiovascular outcome and BP is log-linear and continuous, irrespective of whether BP is measured at the office, 17 or out of the office, either at home or using ambulatory BP monitoring. 18 Thus, there is no critical BP level above which cardiovascular risk suddenly starts rising. Thresholds only serve the need of clinicians to use cutoff limits for the diagnosis and management of hypertension.…”

Section: Diagnostic Thresholdsmentioning

confidence: 99%

Ambulatory Blood Pressure Monitoring to Diagnose and Manage Hypertension

et al. 2021

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This review portrays how ambulatory blood pressure (BP) monitoring was established and recommended as the method of choice for the assessment of BP and for the rational use of antihypertensive drugs. To establish much-needed diagnostic ambulatory BP thresholds, initial statistical approaches evolved into longitudinal studies of patients and populations, which demonstrated that cardiovascular complications are more closely associated with 24-hour and nighttime BP than with office BP. Studies cross-classifying individuals based on ambulatory and office BP thresholds identified white-coat hypertension, an elevated office BP in the presence of ambulatory normotension as a low-risk condition, whereas its counterpart, masked hypertension, carries a hazard almost as high as ambulatory combined with office hypertension. What clinically matters most is the level of the 24-hour and the nighttime BP, while other BP indexes derived from 24-hour ambulatory BP recordings, on top of the 24-hour and nighttime BP level, add little to risk stratification or hypertension management. Ambulatory BP monitoring is cost-effective. Ambulatory and home BP monitoring are complimentary approaches. Their interchangeability provides great versatility in the clinical implementation of out-of-office BP measurement. We are still waiting for evidence from randomized clinical trials to prove that out-of-office BP monitoring is superior to office BP in adjusting antihypertensive drug treatment and in the prevention of cardiovascular complications. A starting research line, the development of a standardized validation protocol for wearable BP monitoring devices, might facilitate the clinical applicability of ambulatory BP monitoring.

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“…In general, relative risk is high in young adults, whereas absolute risk only starts rising from middle age onwards with competing contributions of cardiovascular and noncardiovascular disease to all-cause mortality. 9 , 10 From this perspective, we analyzed the International Database on Ambulatory Blood Pressure in Relation Cardiovascular Outcome (IDACO) database 11 to evaluate the relative and absolute risk associated with PP in young and old adults and to chart the lifecourse prevention of cardiovascular disease associated with arterial stiffening. 1 …”

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Relative and Absolute Risk to Guide the Management of Pulse Pressure, an Age-Related Cardiovascular Risk Factor

Melgarejo

Thijs

Wei

et al. 2021

American Journal of Hypertension

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Background Pulse pressure (PP) reflects the age-related stiffening of the central arteries, but no study addressed the management of the PP-related risk over the human lifespan. Methods In 4663 young (18-49 years) and 7185 older adults (≥50 years), brachial PP was recorded over 24-hour. Total mortality and all major cardiovascular events combined (MACE) were co-primary endpoints. Cardiovascular death, coronary events and stroke were secondary endpoints. Results In young adults (median follow-up, 14.1 years; mean PP, 45.1 mmHg), greater PP was not associated with absolute risk; the endpoint rates were ≤2.01 per 1000 person-years. The adjusted hazard ratios expressed per 10mmHg PP increments were less than unity (P≤0.027) for MACE (0.67; 95% CI, 0.47-0.96) and cardiovascular death (0.33; 95% CI, 0.11-0.75). In older adults (median follow-up, 13.1 years; mean PP, 52.7 mmHg), the endpoint rates, expressing absolute risk, ranged from 22.5 to 45.4 per 1000 person-years and the adjusted hazard ratios, reflecting relative risk, from 1.09 to 1.54 (P<0.0001). The PPrelated relative risks of death, MACE and stroke decreased >3-fold from age 55 to 75 years, whereas absolute risk rose by a factor 3. Conclusions From 50 years onwards, the PP-related relative risk decreases, whereas absolute risk increases. From a lifecourse perspective, young adulthood provides a window of opportunity to manage risk factors and prevent target organ damage as forerunner of premature death and MACE. In older adults, treatment should address absolute risk, thereby extending life in years and quality.

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Opposing Age-Related Trends in Absolute and Relative Risk of Adverse Health Outcomes Associated With Out-of-Office Blood Pressure

Cited by 35 publications

References 42 publications

Association of Fatal and Nonfatal Cardiovascular Outcomes With 24-Hour Mean Arterial Pressure

Association of Fatal and Nonfatal Cardiovascular Outcomes With 24-Hour Mean Arterial Pressure

Ambulatory Blood Pressure Monitoring to Diagnose and Manage Hypertension

Relative and Absolute Risk to Guide the Management of Pulse Pressure, an Age-Related Cardiovascular Risk Factor

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