학술논문
Association of Fatal and Nonfatal Cardiovascular Outcomes With 24-Hour Mean Arterial Pressure
Document Type
Author
Melgarejo, Jesus D.; Yang, Wen-Yi; Thijs, Lutgarde; Li, Yan; Asayama, Kei; Hansen, Tine W.; Wei, Fang-Fei; Kikuya, Masahiro; Ohkubo, Takayoshi; Dolan, Eamon; Stolarz-Skrzypek, Katarzyna; Huang, Qi-Fang; Tikhonoff, Valerie; Malyutina, Sofia; Casiglia, Edoardo; Lind, Lars; Sandoya, Edgardo; Filipovsky, Jan; Gilis-Malinowska, Natasza; Narkiewicz, Krzysztof; Kawecka-Jaszcz, Kalina; Boggia, Jose; Wang, Ji-Guang; Imai, Yutaka; Vanassche, Thomas; Verhamme, Peter; Janssens, Stefan; O'Brien, Eoin; Maestre, Gladys E.; Staessen, Jan A.; Zhang, Zhen-Yu
Source
Hypertension. 77(1):39-48
Subject
Language
English
ISSN
2011-2947
Abstract
Major adverse cardiovascular events are closely associated with 24-hour blood pressure (BP). We determined outcome-driven thresholds for 24-hour mean arterial pressure (MAP), a BP index estimated by oscillometric devices. We assessed the association of major adverse cardiovascular events with 24-hour MAP, systolic BP (SBP), and diastolic BP (DBP) in a population-based cohort (n=11 596). Statistics included multivariable Cox regression and the generalized R-2 statistic to test model fit. Baseline office and 24-hour MAP averaged 97.4 and 90.4 mm Hg. Over 13.6 years (median), 2034 major adverse cardiovascular events occurred. Twenty-four-hour MAP levels of <90 (normotension, n=6183), 90 to <92 (elevated MAP, n=909), 92 to <96 (stage-1 hypertension, n=1544), and >= 96 (stage-2 hypertension, n=2960) mm Hg yielded equivalent 10-year major adverse cardiovascular events risks as office MAP categorized using 2017 American thresholds for office SBP and DBP. Compared with 24-hour MAP normotension, hazard ratios were 0.96 (95% CI, 0.80-1.16), 1.32 (1.15-1.51), and 1.77 (1.59-1.97), for elevated and stage-1 and stage-2 hypertensive MAP. On top of 24-hour MAP, higher 24-hour SBP increased, whereas higher 24-hour DBP attenuated risk (P<0.001). Considering the 24-hour measurements, R-2 statistics were similar for SBP (1.34) and MAP (1.28), lower for DBP than for MAP (0.47), and reduced to null, if the base model included SBP and DBP; if the ambulatory BP indexes were dichotomized according to the 2017 American guideline and the proposed 92 mm Hg for MAP, the R-2 values were 0.71, 0.89, 0.32, and 0.10, respectively. In conclusion, the clinical application of 24-hour MAP thresholds in conjunction with SBP and DBP refines risk estimates.