Definition of ambulatory blood pressure targets for diagnosis and treatment of hypertension in relation to clinic blood pressure: Prospective cohort study

Head, Geoffrey A., Mihailidou, Anastasia S., Duggan, Karen A., Beilin, Lawrence J., Berry, Narelle, Brown, Mark A., Bune, Alex J., Cowley, Diane, Chalmers, John P., Howe, Peter R. C., Hodgson, Jonathan, Ludbrook, John, Mangoni, Arduino A., McGrath, Barry P., Nelson, Mark R., Sharman, James E. and Stowasser, Michael (2010) Definition of ambulatory blood pressure targets for diagnosis and treatment of hypertension in relation to clinic blood pressure: Prospective cohort study. British Medical Journal, 340 7751: 1-8. doi:10.1136/bmj.c1104


Author Head, Geoffrey A.
Mihailidou, Anastasia S.
Duggan, Karen A.
Beilin, Lawrence J.
Berry, Narelle
Brown, Mark A.
Bune, Alex J.
Cowley, Diane
Chalmers, John P.
Howe, Peter R. C.
Hodgson, Jonathan
Ludbrook, John
Mangoni, Arduino A.
McGrath, Barry P.
Nelson, Mark R.
Sharman, James E.
Stowasser, Michael
Title Definition of ambulatory blood pressure targets for diagnosis and treatment of hypertension in relation to clinic blood pressure: Prospective cohort study
Journal name British Medical Journal
ISSN 0959-535X
1468-5833
Publication date 2010-04
Sub-type Article (original research)
DOI 10.1136/bmj.c1104
Volume 340
Issue 7751
Start page 1
End page 8
Total pages 8
Place of publication London, U.K.
Publisher British Medical Association
Collection year 2011
Language eng
Formatted abstract
Background Twenty-four hour ambulatory blood pressure thresholds have been defined for the diagnosis of mild hypertension but not for its treatment or for other blood pressure thresholds used in the diagnosis of moderate to severe hypertension. We aimed to derive age and sex related ambulatory blood pressure equivalents to clinic blood pressure thresholds for diagnosis and treatment of hypertension.

Methods We collated 24 hour ambulatory blood pressure data, recorded with validated devices, from 11 centres across six Australian states (n=8575). We used least product regression to assess the relation between these measurements and clinic blood pressure measured by trained staff and in a smaller cohort by doctors (n=1693).

Results Mean age of participants was 56 years (SD 15) with mean body mass index 28.9 (5.5) and mean clinic systolic/diastolic blood pressure 142/82 mm Hg (19/12); 4626 (54%) were women. Average clinic measurements by trained staff were 6/3 mm Hg higher than daytime ambulatory blood pressure and 10/5 mm Hg higher than 24 hour blood pressure, but 9/7 mm Hg lower than clinic values measured by doctors. Daytime ambulatory equivalents derived from trained staff clinic measurements were 4/3 mm Hg less than the 140/90 mm Hg clinic threshold (lower limit of grade 1 hypertension), 2/2 mm Hg less than the 130/80 mm Hg threshold (target upper limit for patients with associated conditions), and 1/1 mm Hg less than the 125/75 mm Hg threshold. Equivalents were 1/2 mm Hg lower for women and 3/1 mm Hg lower in older people compared with the combined group.

Conclusions Our study provides daytime ambulatory blood pressure thresholds that are slightly lower than equivalent clinic values. Clinic blood pressure measurements taken by doctors were considerably higher than those taken by trained staff and therefore gave inappropriate estimates of ambulatory thresholds. These results provide a framework for the diagnosis and management of hypertension using ambulatory blood pressure values.
Keyword Cardiovascular events
Measuring devices
Recommendations
Management
Risk
Population
Society
Guidelines
Normality
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Medicine Publications
 
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Created: Sun, 02 May 2010, 00:08:07 EST