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
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DOI：
10.1161/circulationaha.106.662254
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发表时间：
2007-04-24
期刊：
影响因子：
37.8
通讯作者：
Staessen, Jan A.
中科院分区：
文献类型：
--
作者：
Kikuya, Masahiro;Hansen, Tine W.;Staessen, Jan A.
背景-当前动态血压(ABP)的诊断阈值主要依赖于来自参考人群的统计参数。方法和结果：我们在丹麦哥本哈根、比利时诺尔德肯本、日本大阪和瑞典乌普萨拉的5682名参与者(平均年龄59.0岁，43.3%女性)中进行了24小时的ABP监测。在多变量分析中，我们确定了ABP阈值，其10年的心血管风险与办公室测量的最佳血压(120/80 mm Hg)、正常血压(130/85 mm Hg)和高血压(140/90 mm Hg)相似。在9.7年(中位数)期间，发生了814次心血管终点，包括377次中风和435次心脏事件。24小时的收缩/舒张期阈值为116.8/74.2 mm Hg，白天为121.6/78.9 mm Hg，夜间为100.9/65.3 mm Hg。正常血压阈值为123.9/76.8、129.9/82.6、110.2/68.1 mm Hg；动态高血压阈值为131.0/79.4、138.2/86.4、119.5/70.8 mm Hg。经过四舍五入后，24小时最佳ABP的近似阈值为115/75 mm Hg，白天为120/80 mm Hg，夜间为100/65 mm Hg。正常ABP的四舍五入阈值分别为125/75、130/85和110/70 mm Hg，动态高血压的四舍五入阈值分别为130/80、140/85和120/70 mm Hg。结论：基于人群的最佳和正常ABP阈值低于目前高血压指南提出的阈值。
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.