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

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...

Full description

Saved in:

Bibliographic Details
Published in:	BMJ Vol. 340; no. 7751; p. 849
Main Authors:	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
Format:	Journal Article
Language:	English
Published:	England British Medical Journal Publishing Group 14-04-2010 British Medical Association BMJ Publishing Group LTD BMJ Publishing Group BMJ Publishing Group Ltd
Edition:	International edition
Subjects:	Adolescent Adult Age Aged Aged, 80 and over Ambulatory blood pressure Ambulatory care Antihypertensives Blood pressure Blood Pressure - physiology Blood Pressure Determination - standards Blood Pressure Monitoring, Ambulatory - standards Cardiovascular disease Circadian Rhythm Epidemiologic Studies Female Hospital units Humans Hypertension Hypertension - diagnosis Hypertension - physiopathology Hypertension - therapy Male Medical diagnosis Medical personnel Medical research Medical treatment Middle Aged Pharmacists Posture Professionals Reference Values Regression analysis Research universities Womens health Young Adult Australia United States > US
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	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.
Bibliography:	ArticleID:heag714386 local:bmj;340/apr14_3/c1104 ark:/67375/NVC-28RRFB4M-2 istex:D68671FD6743CD8ADB450152479593A034262711 PMID:20392760 href:bmj-340-bmj-c1104.pdf ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	0959-8138 0959-8146 1468-5833 1756-1833
DOI:	10.1136/bmj.c1104