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Association of Fatal and Nonfatal Cardiovascular Outcomes With 24-Hour Mean Arterial Pressure
JD. Melgarejo, WY. Yang, L. Thijs, Y. Li, K. Asayama, TW. Hansen, FF. Wei, M. Kikuya, T. Ohkubo, E. Dolan, K. Stolarz-Skrzypek, QF. Huang, V. Tikhonoff, S. Malyutina, E. Casiglia, L. Lind, E. Sandoya, J. Filipovský, N. Gilis-Malinowska, K....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články, Research Support, N.I.H., Extramural, práce podpořená grantem
Grantová podpora
R01 AG036469
NIA NIH HHS - United States
R03 AG054186
NIA NIH HHS - United States
NLK
Free Medical Journals
od 1979 do Před 1 rokem
Open Access Digital Library
od 1979-01-01
Open Access Digital Library
od 1979-01-01
- MeSH
- ambulantní monitorování krevního tlaku * MeSH
- dospělí MeSH
- hypertenze komplikace MeSH
- kardiovaskulární nemoci etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- proporcionální rizikové modely MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Research Support, N.I.H., Extramural MeSH
Major adverse cardiovascular events are closely associated with 24-hour blood pressure (BP). We determined outcome-driven thresholds for 24-hour mean arterial pressure (MAP), a BP index estimated by oscillometric devices. We assessed the association of major adverse cardiovascular events with 24-hour MAP, systolic BP (SBP), and diastolic BP (DBP) in a population-based cohort (n=11 596). Statistics included multivariable Cox regression and the generalized R2 statistic to test model fit. Baseline office and 24-hour MAP averaged 97.4 and 90.4 mm Hg. Over 13.6 years (median), 2034 major adverse cardiovascular events occurred. Twenty-four-hour MAP levels of <90 (normotension, n=6183), 90 to <92 (elevated MAP, n=909), 92 to <96 (stage-1 hypertension, n=1544), and ≥96 (stage-2 hypertension, n=2960) mm Hg yielded equivalent 10-year major adverse cardiovascular events risks as office MAP categorized using 2017 American thresholds for office SBP and DBP. Compared with 24-hour MAP normotension, hazard ratios were 0.96 (95% CI, 0.80-1.16), 1.32 (1.15-1.51), and 1.77 (1.59-1.97), for elevated and stage-1 and stage-2 hypertensive MAP. On top of 24-hour MAP, higher 24-hour SBP increased, whereas higher 24-hour DBP attenuated risk (P<0.001). Considering the 24-hour measurements, R2 statistics were similar for SBP (1.34) and MAP (1.28), lower for DBP than for MAP (0.47), and reduced to null, if the base model included SBP and DBP; if the ambulatory BP indexes were dichotomized according to the 2017 American guideline and the proposed 92 mm Hg for MAP, the R2 values were 0.71, 0.89, 0.32, and 0.10, respectively. In conclusion, the clinical application of 24-hour MAP thresholds in conjunction with SBP and DBP refines risk estimates.
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 University of Padova Italy
Division of Cardiology Department of Internal Medicine University Hospitals Leuven Belgium
Faculty of Medicine Charles University Pilsen Czech Republic
Laboratory of Neurosciences Faculty of Medicine University of Zulia Maracaibo Venezuela
Research Institute Alliance for the Promotion of Preventive Medicine Mechelen Belgium
Section of Geriatrics Department of Public Health and Caring Sciences Uppsala University Sweden
Citace poskytuje Crossref.org
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- $a Melgarejo, Jesus D $u From the Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (J.D.M., W.-Y. Y, L.T., F.-F.W., J.A.S., Z.-Y.Z.) $u Laboratory of Neurosciences, Faculty of Medicine, University of Zulia, Maracaibo, Venezuela (J.D.M., G.E.M)
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- $a Association of Fatal and Nonfatal Cardiovascular Outcomes With 24-Hour Mean Arterial Pressure / $c JD. Melgarejo, WY. Yang, L. Thijs, Y. Li, K. Asayama, TW. Hansen, FF. Wei, M. Kikuya, T. Ohkubo, E. Dolan, K. Stolarz-Skrzypek, QF. Huang, V. Tikhonoff, S. Malyutina, E. Casiglia, L. Lind, E. Sandoya, J. Filipovský, N. Gilis-Malinowska, K. Narkiewicz, K. Kawecka-Jaszcz, J. Boggia, JG. Wang, Y. Imai, T. Vanassche, P. Verhamme, S. Janssens, E. O'Brien, GE. Maestre, JA. Staessen, ZY. Zhang, International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcome Investigators*
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- $a Major adverse cardiovascular events are closely associated with 24-hour blood pressure (BP). We determined outcome-driven thresholds for 24-hour mean arterial pressure (MAP), a BP index estimated by oscillometric devices. We assessed the association of major adverse cardiovascular events with 24-hour MAP, systolic BP (SBP), and diastolic BP (DBP) in a population-based cohort (n=11 596). Statistics included multivariable Cox regression and the generalized R2 statistic to test model fit. Baseline office and 24-hour MAP averaged 97.4 and 90.4 mm Hg. Over 13.6 years (median), 2034 major adverse cardiovascular events occurred. Twenty-four-hour MAP levels of <90 (normotension, n=6183), 90 to <92 (elevated MAP, n=909), 92 to <96 (stage-1 hypertension, n=1544), and ≥96 (stage-2 hypertension, n=2960) mm Hg yielded equivalent 10-year major adverse cardiovascular events risks as office MAP categorized using 2017 American thresholds for office SBP and DBP. Compared with 24-hour MAP normotension, hazard ratios were 0.96 (95% CI, 0.80-1.16), 1.32 (1.15-1.51), and 1.77 (1.59-1.97), for elevated and stage-1 and stage-2 hypertensive MAP. On top of 24-hour MAP, higher 24-hour SBP increased, whereas higher 24-hour DBP attenuated risk (P<0.001). Considering the 24-hour measurements, R2 statistics were similar for SBP (1.34) and MAP (1.28), lower for DBP than for MAP (0.47), and reduced to null, if the base model included SBP and DBP; if the ambulatory BP indexes were dichotomized according to the 2017 American guideline and the proposed 92 mm Hg for MAP, the R2 values were 0.71, 0.89, 0.32, and 0.10, respectively. In conclusion, the clinical application of 24-hour MAP thresholds in conjunction with SBP and DBP refines risk estimates.
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