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Opposing Age-Related Trends in Absolute and Relative Risk of Adverse Health Outcomes Associated With Out-of-Office Blood Pressure
Y. Li, L. Thijs, ZY. Zhang, K. Asayama, TW. Hansen, J. Boggia, K. Björklund-Bodegård, WY. Yang, TJ. Niiranen, A. Ntineri, FF. Wei, M. Kikuya, T. Ohkubo, E. Dolan, A. Hozawa, I. Tsuji, K. Stolarz-Skrzypek, QF. Huang, JD. Melgarejo, V. Tikhonoff,...
Language English Country United States
Document type Journal Article, Meta-Analysis, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Review
Grant support
R01 AG036469
NIA NIH HHS - United States
R03 AG054186
NIA NIH HHS - United States
U01 DK060963
NIDDK NIH HHS - United States
NLK
Free Medical Journals
from 1979 to 1 year ago
Open Access Digital Library
from 1979-01-01
Open Access Digital Library
from 1979-01-01
- MeSH
- Blood Pressure Monitoring, Ambulatory MeSH
- Risk Assessment MeSH
- Hypertension diagnosis epidemiology MeSH
- Internationality MeSH
- Cardiovascular Diseases diagnosis epidemiology MeSH
- Cohort Studies MeSH
- Middle Aged MeSH
- Humans MeSH
- Blood Pressure Determination methods MeSH
- Multivariate Analysis MeSH
- Office Visits trends MeSH
- Proportional Hazards Models MeSH
- Self-Management statistics & numerical data MeSH
- Aged MeSH
- Sex Factors MeSH
- Age Factors MeSH
- Health Status MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
- Research Support, N.I.H., Extramural MeSH
Participant-level meta-analyses assessed the age-specific relevance of office blood pressure to cardiovascular complications, but this information is lacking for out-of-office blood pressure. At baseline, daytime ambulatory (n=12 624) or home (n=5297) blood pressure were measured in 17 921 participants (51.3% women; mean age, 54.2 years) from 17 population cohorts. Subsequently, mortality and cardiovascular events were recorded. Using multivariable Cox regression, floating absolute risk was computed across 4 age bands (≤60, 61-70, 71-80, and >80 years). Over 236 491 person-years, 3855 people died and 2942 cardiovascular events occurred. From levels as low as 110/65 mm Hg, risk log-linearly increased with higher out-of-office systolic/diastolic blood pressure. From the youngest to the oldest age group, rates expressed per 1000 person-years increased (P<0.001) from 4.4 (95% CI, 4.0-4.7) to 86.3 (76.1-96.5) for all-cause mortality and from 4.1 (3.9-4.6) to 59.8 (51.0-68.7) for cardiovascular events, whereas hazard ratios per 20-mm Hg increment in systolic out-of-office blood pressure decreased (P≤0.0033) from 1.42 (1.19-1.69) to 1.09 (1.05-1.12) and from 1.70 (1.51-1.92) to 1.12 (1.07-1.17), respectively. These age-related trends were similar for out-of-office diastolic pressure and were generally consistent in both sexes and across ethnicities. In conclusion, adverse outcomes were directly associated with out-of-office blood pressure in adults. At young age, the absolute risk associated with out-of-office blood pressure was low, but relative risk high, whereas with advancing age relative risk decreased and absolute risk increased. These observations highlight the need of a lifecourse approach for the management of hypertension.
Asociación Española Primera de Socorros Mutuos Montevideo Uruguay
Conway Institute University College Dublin Ireland
Department of Hygiene and Public Health Teikyo University School of Medicine Tokyo Japan
Department of Hypertension Medical University of Gdańsk Poland
Department of Medicine Hospital Italiano de Buenos Aires University of Buenos Aires Argentina
Department of Medicine University of Padova Italy
Department of Public Health and Caring Sciences Section of Geriatrics Uppsala University Sweden
Department of Public Health Tohoku University Graduate School of Medicine Sendai Japan
Faculty of Medicine Charles University Pilsen Czech Republic
Laboratorio de Neurociencias and Instituto Cardiovascular Universidad del Zulia Maracaibo Venezuela
References provided by Crossref.org
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- $a Participant-level meta-analyses assessed the age-specific relevance of office blood pressure to cardiovascular complications, but this information is lacking for out-of-office blood pressure. At baseline, daytime ambulatory (n=12 624) or home (n=5297) blood pressure were measured in 17 921 participants (51.3% women; mean age, 54.2 years) from 17 population cohorts. Subsequently, mortality and cardiovascular events were recorded. Using multivariable Cox regression, floating absolute risk was computed across 4 age bands (≤60, 61-70, 71-80, and >80 years). Over 236 491 person-years, 3855 people died and 2942 cardiovascular events occurred. From levels as low as 110/65 mm Hg, risk log-linearly increased with higher out-of-office systolic/diastolic blood pressure. From the youngest to the oldest age group, rates expressed per 1000 person-years increased (P<0.001) from 4.4 (95% CI, 4.0-4.7) to 86.3 (76.1-96.5) for all-cause mortality and from 4.1 (3.9-4.6) to 59.8 (51.0-68.7) for cardiovascular events, whereas hazard ratios per 20-mm Hg increment in systolic out-of-office blood pressure decreased (P≤0.0033) from 1.42 (1.19-1.69) to 1.09 (1.05-1.12) and from 1.70 (1.51-1.92) to 1.12 (1.07-1.17), respectively. These age-related trends were similar for out-of-office diastolic pressure and were generally consistent in both sexes and across ethnicities. In conclusion, adverse outcomes were directly associated with out-of-office blood pressure in adults. At young age, the absolute risk associated with out-of-office blood pressure was low, but relative risk high, whereas with advancing age relative risk decreased and absolute risk increased. These observations highlight the need of a lifecourse approach for the management of hypertension.
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- 700 1_
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- 700 1_
- $a Wei, Fang-Fei $u Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., Z.-Y.Z., W.-Y.Y., F.-F.W., T.K., J.A.S.).
- 700 1_
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- 700 1_
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- 700 1_
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- 700 1_
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- 700 1_
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