The new American College of Cardiology/American Heart Association guideline reclassified office blood pressure and proposed thresholds for ambulatory blood pressure (ABP). We derived outcome-driven ABP thresholds corresponding with the new office blood pressure categories. We performed 24-hour 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 office blood pressure (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 end point, systolic/diastolic outcome-driven thresholds indicating elevated 24-hour, 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-hour 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 end points were similar. After rounding, approximate thresholds for elevated 24-hour, 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 American College of Cardiology/American Heart Association guideline.

1st Department of Cardiology Interventional Electrocardiology and Hypertension Jagiellonian University Medical College Krakow Poland

Asociación Española Primera de Socorros Mutuos Montevideo Uruguay

Cardiovascular Research Institute Maastricht Maastricht University the Netherlands

Centro de Nefrología and Departamento de Fisiopatología Hospital de Clínicas Universidad de la República Montevideo Uruguay

Conway Institute of Biomolecular and Biomedical Research University College Dublin Ireland

Department of Hygiene and Public Health Teikyo University School of Medicine Tokyo Japan

Department of Hypertension and Diabetology Hypertension Unit Medical University of Gdańsk Poland

Department of Medicine University of Padua Italy

Department of Neurosciences and Department of Human Genetics University of Texas Rio Grande Valley School of Medicine Brownsville

Department of Planning for Drug Development and Clinical Evaluation Tohoku Institute for Management of Blood Pressure Sendai Japan

Faculty of Medicine Charles University Pilsen Czech Republic

From the Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation Shanghai Institute of Hypertension Shanghai Key Laboratory of Hypertension Ruijin Hospital Shanghai Jiao Tong University School of Medicine China

Institute of Internal and Preventive Medicine Institute of Cytology and Genetics Siberian Branch of the Russian Academy of Sciences Novosibirsk Russian Federation

Laboratorio de Neurociencias and Instituto de Enfermedades Cardiovasculares Universidad del Zulia Maracaibo Venezuela

Research Unit Hypertension and Cardiovascular Epidemiology KU Leuven Department of Cardiovascular Sciences University of Leuven Belgium

Section of Geriatrics Department of Public Health and Caring Sciences Uppsala University Sweden

Steno Diabetes Center Copenhagen Gentofte and Center for Health Capital Region of Denmark Denmark

Stroke and Hypertension Unit Blanchardstown Dublin Ireland

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