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The new ACC/AHA guideline reclassified office blood pressure (OBP) and proposed thresholds for ambulatory blood pressure (ABP). We derived outcome-driven ABP thresholds corresponding with the new OBP categories. We performed 24-h ABP monitoring in 11,152 participants (48.9% women; mean age 53.0 years) representative of 13 populations. We determined ABP thresholds resulting in multivariable-adjusted 10-year risks similar to those associated with elevated OBP (120/80 mm Hg) and stages 1 and 2 of office hypertension (130/80 and 140/90 mm Hg). Over 13.9 years (median), 2728 (rate per 1000 person-years, 17.9) people died, 1033 (6.8) from cardiovascular disease; furthermore, 1988 (13.8), 893 (6.0) and 795 (5.4) cardiovascular and coronary events and strokes occurred. Using a composite cardiovascular endpoint, systolic/diastolic outcome-driven thresholds indicating elevated 24-h, daytime and nighttime ABP were 117.9/75.2, 121.4/79.6 and 105.3/66.2 mm Hg. For stages 1 and -2 ambulatory hypertension, thresholds were 123.3/75.2 and 128.7/80.7 mm Hg for 24-h ABP, 128.5/79.6 and 135.6/87.1 mm Hg for daytime ABP and 111.7/66.2 and 118.1/72.5 mm Hg for nighttime ABP. ABP thresholds derived from other endpoints were similar. After rounding, approximate thresholds for elevated 24-h, daytime and nighttime ABP were 120/75, 120/80 and 105/65 mm Hg and for stages 1 and 2 ambulatory hypertension 125/75 and 130/80 mm Hg, 130/80 and 135/85 mm Hg, and 110/65 and 120/70 mm Hg. Outcome-driven ABP thresholds corresponding to elevated blood pressure and stages 1 and 2 of hypertension are similar to those proposed by the current ACC/AHA guideline.


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