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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

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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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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

DOI: doi:10.1136/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:Medical and Health Sciences
Research Group:Cardiorespiratory 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
Author:Nelson, MR (Professor Mark Nelson)
Author:Sharman, JE (Professor James Sharman)
ID Code:65368
Year Published:2010
Web of Science® Times Cited:84
Deposited By:Menzies Institute for Medical Research
Deposited On:2010-11-09
Last Modified:2011-05-02
Downloads:221 View Download Statistics

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