Association of Fatal and Nonfatal Cardiovascular Outcomes With 24-Hour Mean Arterial Pressure
Jesús D. Melgarejo, Wen‐Yi Yang, Lutgarde Thijs, Yan Li, Kei Asayama, Tine W. Hansen, Fang‐Fei Wei, Masahiro Kikuya, Takayoshi Ohkubo, Eamon Dolan, Katarzyna Stolarz‐Skrzypek, Qi‐Fang Huang, Valérie Tikhonoff, Sofia Malyutina, Edoardo Casiglia, Lars Lind, Edgardo Sandoya, Jan Filipovský, Natasza Gilis‐Malinowska, Krzysztof Narkiewicz, Kalina Kawecka−Jaszcz, José Boggia, Ji‐Guang Wang, Yutaka Imai, Thomas Vanassche, Peter Verhamme, Stefan Janssens, Eoin OʼBrien, Gladys E. Maestre, Jan A. Staessen, Zhen‐Yu Zhang, Jitka Seidlerová, Marie Tichá, Hans Ibsen, Jørgen Jeppesen, S. Rasmussen, C. Torp-Pedersen, A Pizzioli, Junichiro Hashimoto, H. Hoshi, Ryusuke Inoue, Hirohito Metoki, T. Obara, Hiroshi Satoh, Kazuhito Totsune, Agata Adamkiewicz-Piejko, Marcin Cwynar, Jerzy Gąsowski, Tomasz Grodzicki, Wojciech Lubaszewski, Agnieszka Olszanecka, Barbara Wizner, Wiktoria Wojciechowska, Jolanta Życzkowska, Y. Nikitin, Elena Pello, Gabriela Šimonová, М. И. Воевода, B. Andrén, Lars Berglund, Kristina Björklund‐Bodegârd, Björn Zethelius, Marzia Bianchi, Virgílio Garcia Moreira, Carlos Schettini, Emma Schwedt, Hugo Senra
Abstract
Major adverse cardiovascular events are closely associated with 24-hour blood pressure (BP). We determined outcome-driven thresholds for 24-hour mean arterial pressure (MAP), a BP index estimated by oscillometric devices. We assessed the association of major adverse cardiovascular events with 24-hour MAP, systolic BP (SBP), and diastolic BP (DBP) in a population-based cohort (n=11 596). Statistics included multivariable Cox regression and the generalized R 2 statistic to test model fit. Baseline office and 24-hour MAP averaged 97.4 and 90.4 mm Hg. Over 13.6 years (median), 2034 major adverse cardiovascular events occurred. Twenty-four-hour MAP levels of <90 (normotension, n=6183), 90 to <92 (elevated MAP, n=909), 92 to <96 (stage-1 hypertension, n=1544), and ≥96 (stage-2 hypertension, n=2960) mm Hg yielded equivalent 10-year major adverse cardiovascular events risks as office MAP categorized using 2017 American thresholds for office SBP and DBP. Compared with 24-hour MAP normotension, hazard ratios were 0.96 (95% CI, 0.80–1.16), 1.32 (1.15–1.51), and 1.77 (1.59–1.97), for elevated and stage-1 and stage-2 hypertensive MAP. On top of 24-hour MAP, higher 24-hour SBP increased, whereas higher 24-hour DBP attenuated risk ( P <0.001). Considering the 24-hour measurements, R 2 statistics were similar for SBP (1.34) and MAP (1.28), lower for DBP than for MAP (0.47), and reduced to null, if the base model included SBP and DBP; if the ambulatory BP indexes were dichotomized according to the 2017 American guideline and the proposed 92 mm Hg for MAP, the R 2 values were 0.71, 0.89, 0.32, and 0.10, respectively. In conclusion, the clinical application of 24-hour MAP thresholds in conjunction with SBP and DBP refines risk estimates.