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Definition of ambulatory blood pressure targets for diagnosis and treatment of hypertension in relation to clinic blood pressure: prospective cohort study
Citation
Head, GA and Mihailidou, AS and Duggan, KA and Beilin, LJ and Berry, N and Brown, MA and Bune, AJ and Cowley, D and Chalmers, JP and Howe, PRC and Hodgson, J and Ludbrook, J and Mangoni, AA and McGrath, BP and Nelson, MR and Sharman, JE and Stowasser, M, Definition of ambulatory blood pressure targets for diagnosis and treatment of hypertension in relation to clinic blood pressure: prospective cohort study , B M J , 340, (c1104 April) EJ ISSN 1756-1833 (2010) [Refereed Article]
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Copyright Statement
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License http://creativecommons.org/licenses/by-nc/2.0/
Official URL: http://www.bmj.com/content/340/bmj.c1104
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 142/82mmHg (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 4/3mmHg less than the 140/90mm
Hg clinic threshold (lower limit of grade 1 hypertension),
2/2mmHg less than the 130/80mmHg 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.
Item Details
| Item Type: | Refereed Article |
|---|---|
| Research Division: | Biomedical and Clinical Sciences |
| Research Group: | Cardiovascular medicine and haematology |
| Research Field: | Cardiology (incl. cardiovascular diseases) |
| Objective Division: | Health |
| Objective Group: | Public health (excl. specific population health) |
| Objective Field: | Public health (excl. specific population health) not elsewhere classified |
| UTAS Author: | Nelson, MR (Professor Mark Nelson) |
| UTAS Author: | Sharman, JE (Professor James Sharman) |
| ID Code: | 65368 |
| Year Published: | 2010 |
| Web of Science® Times Cited: | 87 |
| Deposited By: | Menzies Institute for Medical Research |
| Deposited On: | 2010-11-09 |
| Last Modified: | 2011-05-02 |
| Downloads: | 348 View Download Statistics |
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