A1 Refereed original research article in a scientific journal
Opposing Age-Related Trends in Absolute and Relative Risk of Adverse Health Outcomes Associated With Out-of-Office Blood Pressure
Authors: Yan Li, Lutgarde Thijs, Zhen-Yu Zhang, Kei Asayama, Tine W. Hansen, José Boggia, Kristina Björklund-Bodegård, Wen-Yi Yang, Teemu J. Niiranen, Angeliki Ntineri, Fang-Fei Wei, Masahiro Kikuya, Takayoshi Ohkubo, Eamon Dolan, Atsushi Hozawa, Ichiro Tsuji, Katarzyna Stolarz-Skrzypek, Qi-Fang Huang, Jesus D. Melgarejo, Valérie Tikhonoff, Sofia Malyutina, Edoardo Casiglia, Yuri Nikitin, Lars Lind, Edgardo Sandoya, Lucas Aparicio, Jessica Barochiner, Natasza Gilis-Malinowska, Krzysztof Narkiewicz, Kalina Kawecka-Jaszcz, Gladys E. Maestre, Antti M. Jula, Jouni K. Johansson, Tatiana Kuznetsova, Jan Filipovský, George Stergiou, Ji-Guang Wang, Yutaka Imai, Eoin O'Brien, Jan A. Staessen
Publisher: LIPPINCOTT WILLIAMS & WILKINS
Publication year: 2019
Journal: Hypertension
Journal name in source: HYPERTENSION
Journal acronym: HYPERTENSION
Volume: 74
Issue: 6
First page : 1333
Last page: 1342
Number of pages: 10
ISSN: 0194-911X
eISSN: 1524-4563
DOI: https://doi.org/10.1161/HYPERTENSIONAHA.119.12958
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/44884338
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.
Downloadable publication This is an electronic reprint of the original article. |  |
