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.
Cheng, Y. B., Thijs, L., Zhang, Z. Y., Kikuya, M., Yang, W. Y., Melgarejo, J. D., Boggia, J., Wei, F. F., Hansen, T. W., Yu, C. G., Asayama, K., Ohkubo, T., Dolan, E., Stolarz-Skrzypek, K., Malyutina, S., Casiglia, E., Lind, L., Filipovský, J., Maestre, G. E., Imai, Y., … Staessen, J. A. (2019). Outcome-Driven Thresholds for Ambulatory Blood Pressure Based on the New American College of Cardiology/American Heart Association Classification of Hypertension. Hypertension (Dallas, Tex. : 1979), 74(4), 776–783. https://doi.org/10.1161/HYPERTENSIONAHA.119.13512