Definition of ambulatory blood pressure targets for diagnosis and treatment of hypertension in relation to clinic blood pressure: prospective cohort study

Geoffrey A Head, Anastasia S Mihailidou, Karen A Duggan, Lawrence J Beilin, Narelle Berry, Mark A Brown, Alex J Bune, Diane Cowley, John P Chalmers, Peter R C Howe, Jonathan Hodgson, John Ludbrook, Arduino A Mangoni, Barry P McGrath, Mark R Nelson, James E Sharman, Michael Stowasser, Ambulatory Blood Pressure Working Group of the High Blood Pressure Research Council of Australia, Geoffrey A Head, Anastasia S Mihailidou, Karen A Duggan, Lawrence J Beilin, Narelle Berry, Mark A Brown, Alex J Bune, Diane Cowley, John P Chalmers, Peter R C Howe, Jonathan Hodgson, John Ludbrook, Arduino A Mangoni, Barry P McGrath, Mark R Nelson, James E Sharman, Michael Stowasser, Ambulatory Blood Pressure Working Group of the High Blood Pressure Research Council of Australia

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 142/82 mm Hg (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 4/3 mm Hg less than the 140/90 mm Hg clinic threshold (lower limit of grade 1 hypertension), 2/2 mm Hg less than the 130/80 mm Hg 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.

Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form, which is available on request from the corresponding author. The authors declare that (1) no authors have support from any company for the submitted work; (2) no authors have any relationships with companies that might have an interest in the submitted work in the previous 3 years; (3) their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and (4) no authors have non-financial interests that may be relevant to the submitted work.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4787671/bin/heag714386.f1_default.jpg
Pearson correlation between seated clinic systolic and diastolic blood pressure and 24 hour, daytime, and night time ambulatory blood pressure measurements in 5327 participants for whom measurements were available. Dashed lines indicate least squares linear regression (LSR), straight lines indicate ordinary least product (OLP) linear regression. Intercept, slope, and correlation coefficient (r) is shown for each OLP regression

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