Diagnostic thresholds for ambulatory blood pressure monitoring based on 10-year cardiovascular risk
Diagnostic thresholds for ambulatory blood pressure monitoring based on 10-year cardiovascular risk
复制标题
DOI：
10.1097/mbp.0b013e3282f2b53d
复制
发表时间：
2007-12-01
影响因子：
1.3
通讯作者：
Staessen, Jan A.
中科院分区：
文献类型：
--
作者：
Kikuya, Masahiro;Hansen, Jine W.;Staessen, Jan A.
目前动态血压（ABP）的诊断阈值主要依赖于参考人群的统计参数。我们为 ABP 测量确定了一个结果驱动的参考框架。我们对在丹麦哥本哈根参加前瞻性人口研究的 5682 名参与者（平均年龄 59.0 岁；43.3% 女性）进行了 24 小时 ABP 监测；比利时诺德肯彭；日本大坂；和瑞典乌普萨拉。在多变量分析中，我们确定了 ABP 阈值，该阈值产生的 10 年心血管风险与办公室测量的最佳血压（120/80 mmHg）、正常血压（130/85 mmHg）和高血压（140/90 mmHg）相关。在 9.7 年（中位数）的时间里，发生了 814 个心血管终点事件，其中包括 377 例中风和 435 例心脏事件。最佳 ABP 的收缩压/舒张压阈值为 24 小时 118.3/74.2 mmHg，白天 121.6/78.9 mmHg，夜间 104.7/65.3 mmHg。正常ABP的相应阈值分别为124.3/76.8、129.9/82.6和111.6/68.1 mmHg，动态高血压的相应阈值分别为130.3/79.4、138.2/86.4和118.5/70.8 mmHg。舍入后，最佳 ABP 的近似阈值为 24 小时 115/75 mmHg、白天 120/80 mmHg、夜间 105/65 mmHg。正常 ABP 的舍入阈值分别为 125/75、130/85 和 110/70 mmHg，动态高血压的舍入阈值分别为 130/80、140/85 和 120/70 mmHg。总之，基于人群的最佳和正常 ABP 的结果驱动阈值低于高血压指南目前提出的阈值。
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. We performed 24-h 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 mmHg), normal (130/85 mmHg), and high (140/90 mmHg) 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 118.3/74.2 mmHg for 24 h, 121.6/78.9 mmHg for daytime, and 104.7/65.3 mmHg for nighttime. Corresponding thresholds for normal ABP were 124.3/76.8,129.9/82.6, and 111.6/68.1 mmHg, respectively, and those for ambulatory hypertension were 130.3/79.4, 138.2/86.4, and 118.5/70.8 mmHg. After rounding, approximate thresholds for optimal ABP amounted to 115/75 mmHg for 24 h, 120/80 mmHg for daytime, and 105/65 mmHg for nighttime. Rounded thresholds for normal ABP were 125/75,130/85, and 110/70 mmHg, respectively, and those for ambulatory hypertension were 130/80, 140/85, and 120/70 mmHg. In conclusion, population-based outcome-driven thresholds for optimal and normal ABP are lower than those currently proposed by hypertension guidelines.