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(Circulation. 2007;115:2145-2152.)
© 2007 American Heart Association, Inc.

Hypertension

Diagnostic Thresholds for Ambulatory Blood Pressure Monitoring Based on 10-Year Cardiovascular Risk

Masahiro Kikuya, MD, PhD; Tine W. Hansen, MD, PhD; Lutgarde Thijs, MSc; Kristina Björklund-Bodegård, MD, PhD; Tatiana Kuznetsova, MD, PhD; Takayoshi Ohkubo, MD, PhD; Tom Richart, MD, MBE; Christian Torp-Pedersen, MD, PhD; Lars Lind, MD, PhD; Hans Ibsen, MD, PhD; Yutaka Imai, MD, PhD; Jan A. Staessen, MD, PhD, on behalf of the International Database on Ambulatory blood pressure monitoring in relation to Cardiovascular Outcomes (IDACO) Investigators

From the Tohoku University Graduate School of Pharmaceutical Science and Medicine, Sendai, Japan (M.K., T.O., Y.I.); the Research Center for Prevention and Health, Copenhagen, Denmark (T.W.H.); the Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium (M.K., L.T., T.K., T.R., J.A.S.); the Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden (K.B.-B., L.L.); and the Copenhagen University Hospital, Copenhagen, Denmark (T.W.H., C.T.-P., H.I.).

Correspondence to Jan A. Staessen, MD, PhD, Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Campus Gasthuisberg, Herestraat 49, Box 702, B-3000 Leuven, Belgium. E-mail jan.staessen{at}med.kuleuven.be

Received August 31, 2006; accepted February 16, 2007.

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.

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