Blood pressure load does not add to ambulatory blood pressure level for cardiovascular risk stratification

Research output: Contribution to journalJournal articleResearchpeer-review

  • Yan Li
  • Lutgarde Thijs
  • José Boggia
  • Kei Asayama
  • Tine W Hansen
  • Masahiro Kikuya
  • Kristina Björklund-Bodegård
  • Takayoshi Ohkubo
  • Jørgen Jeppesen
  • Torp-Pedersen, Christian Tobias
  • Eamon Dolan
  • Tatiana Kuznetsova
  • Katarzyna Stolarz-Skrzypek
  • Valérie Tikhonoff
  • Sofia Malyutina
  • Edoardo Casiglia
  • Yuri Nikitin
  • Lars Lind
  • Edgardo Sandoya
  • Kalina Kawecka-Jaszcz
  • Jan Filipovsky
  • Yutaka Imai
  • Hans Ibsen
  • Eoin O'Brien
  • Jiguang Wang
  • Jan A Staessen
  • International Database on Ambulatory blood pressure in relation to Cardiovascular Outcomes (IDACO) Investigators*

Experts proposed blood pressure (BP) load derived from 24-hour ambulatory BP recordings as a more accurate predictor of outcome than level, in particular in normotensive people. We analyzed 8711 subjects (mean age, 54.8 years; 47.0% women) randomly recruited from 10 populations. We expressed BP load as percentage (%) of systolic/diastolic readings ≥135/≥85 mm Hg and ≥120/≥70 mm Hg during day and night, respectively, or as the area under the BP curve (mm Hg×h) using the same ceiling values. During a period of 10.7 years (median), 1284 participants died and 1109 experienced a fatal or nonfatal cardiovascular end point. In multivariable-adjusted models, the risk of cardiovascular complications gradually increased across deciles of BP level and load (P<0.001), but BP load did not substantially refine risk prediction based on 24-hour systolic or diastolic BP level (generalized R(2) statistic ≤0.294%; net reclassification improvement ≤0.28%; integrated discrimination improvement ≤0.001%). Systolic/diastolic BP load of 40.0/42.3% or 91.8/73.6 mm Hg×h conferred a 10-year risk of a composite cardiovascular end point similar to a 24-hour systolic/diastolic BP of 130/80 mm Hg. In analyses dichotomized according to these thresholds, increased BP load did not refine risk prediction in the whole study population (R(2)≤0.051) or in untreated participants with 24-hour ambulatory normotension (R(2)≤0.034). In conclusion, BP load does not improve risk stratification based on 24-hour BP level. This also applies to subjects with normal 24-hour BP for whom BP load was proposed to be particularly useful in risk stratification.

Original languageEnglish
JournalHypertension
Volume63
Issue number5
Pages (from-to)925-933
Number of pages9
ISSN0194-911X
DOIs
Publication statusPublished - 2014

    Research areas

  • Adult, Aged, Area Under Curve, Blood Pressure, Blood Pressure Monitoring, Ambulatory, Cardiovascular Diseases, Circadian Rhythm, Female, Humans, Hypertension, Incidence, Male, Middle Aged, Multivariate Analysis, Predictive Value of Tests, Prospective Studies, Retrospective Studies, Risk Factors

ID: 137631180