Outcome-Driven Thresholds for Ambulatory Blood Pressure Based on the New American College of Cardiology/American Heart Association Classification of Hypertension
Outcome-Driven Thresholds for Ambulatory Blood Pressure Based on the New American College of Cardiology/American Heart Association Classification of Hypertension
复制标题
基于美国心脏病学会/美国心脏协会新高血压分类的动态血压结果驱动阈值
DOI：
10.1161/hypertensionaha.119.13512
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发表时间：
2019-10-01
期刊：
影响因子：
8.3
通讯作者：
Staessen, Jan A.
中科院分区：
文献类型：
--
作者：
Cheng, Yi-Bang;Thijs, Lutgarde;Staessen, Jan A.
新的美国心脏病学会/美国心脏协会指南对办公室血压进行了重新分类，并提出了动态血压（ABP）的阈值。我们推导出与新的办公室血压类别相对应的结果驱动的ABP阈值。我们对11152名参与者（48.9%为女性;平均年龄53.0岁）进行了24小时ABP监测，这些参与者代表13个人群。我们确定了ABP阈值，其多变量调整后的10年风险与办公室血压升高（120/80 mm Hg）和办公室高血压1期和2期（130/80和140/90 mm Hg）相关。在13.9年（中位数）中，2728人（每1000人-年的死亡率，17.9）死亡，1033人（6.8）死于心血管疾病;此外，1988（13.8），893（6.0）和795（5.4）心血管和冠状动脉事件和中风发生。使用复合心血管终点，表明24小时、日间和夜间ABP升高的收缩/舒张结局驱动阈值分别为117.9/75.2、121.4/79.6和105.3/66.2 mm Hg。对于1期和2期动态高血压，24小时ABP的阈值分别为123.3/75.2和128.7/80.7 mm Hg，日间ABP为128.5/79.6和135.6/87.1 mm Hg，夜间ABP为111.7/66.2和118.1/72.5 mm Hg。其他终点的ABP阈值相似。四舍五入后，24小时、日间和夜间ABP升高的近似阈值分别为120/75、120/80和105/65 mmHg，1期和2期动态高血压分别为125/75和130/80 mmHg、130/80和135/85 mmHg以及110/65和120/70 mmHg。结果驱动的ABP阈值对应于血压升高和高血压1期和2期，与当前美国心脏病学会/美国心脏协会指南提出的阈值相似。
The new American College of Cardiology/American Heart Association guideline reclassified office blood pressure and proposed thresholds for ambulatory blood pressure (ABP). We derived outcome-driven ABP thresholds corresponding with the new office blood pressure categories. We performed 24-hour ABP monitoring in 11 152 participants (48.9% women; mean age, 53.0 years) representative of 13 populations. We determined ABP thresholds resulting in multivariable-adjusted 10-year risks similar to those associated with elevated office blood pressure (120/80 mm Hg) and stages 1 and 2 of office hypertension (130/80 and 140/90 mm Hg). Over 13.9 years (median), 2728 (rate per 1000 person-years, 17.9) people died, 1033 (6.8) from cardiovascular disease; furthermore, 1988 (13.8), 893 (6.0), and 795 (5.4) cardiovascular and coronary events and strokes occurred. Using a composite cardiovascular end point, systolic/diastolic outcome-driven thresholds indicating elevated 24-hour, daytime, and nighttime ABP were 117.9/75.2, 121.4/79.6, and 105.3/66.2 mm Hg. For stages 1 and 2 ambulatory hypertension, thresholds were 123.3/75.2 and 128.7/80.7 mm Hg for 24-hour ABP, 128.5/79.6 and 135.6/87.1 mm Hg for daytime ABP, and 111.7/66.2 and 118.1/72.5 mm Hg for nighttime ABP. ABP thresholds derived from other end points were similar. After rounding, approximate thresholds for elevated 24-hour, daytime, and nighttime ABP were 120/75, 120/80, and 105/65 mm Hg, and for stages 1 and 2, ambulatory hypertension 125/75 and 130/80 mm Hg, 130/80 and 135/85 mm Hg, and 110/65 and 120/70 mm Hg. Outcome-driven ABP thresholds corresponding to elevated blood pressure and stages 1 and 2 of hypertension are similar to those proposed by the current American College of Cardiology/American Heart Association guideline.