医学
动态血压
危险系数
回廊的
血压
内科学
心脏病学
比例危险模型
舒张期
心力衰竭
队列
铲斗
高血压前期
心率
原发性高血压
白大衣高血压
血流动力学
平均血压
昼夜节律
置信区间
作者
John W. McEvoy,Wen-Yi Yang,Lutgarde Thijs,Zhenyu Zhang,Jesus D. Melgarejo,José Boggia,Tine W. Hansen,Kei Asayama,Takayoshi Ohkubo,Eamon Dolan,Katarzyna Stolarz-Skrzypek,Sofia Malyutina,Edoardo Casiglia,Lars Lind,Jan Filipovský,Gladys E. Maestre,Yan Li,Ji-Guang Wang,Yutaka Imai,Kalina Kawecka-Jaszcz,Edgardo Sandoya,Krzysztof Narkiewicz,Eoin O'Brien,Thomas Vanassche,Jan A. Staessen
出处
期刊:Hypertension
[Ovid Technologies (Wolters Kluwer)]
日期:2021-10-04
卷期号:78 (5): 1222-1231
被引量:5
标识
DOI:10.1161/hypertensionaha.121.17766
摘要
The prognostic implications of isolated diastolic hypertension (IDH), as defined by 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines, have not been tested using ambulatory blood pressure (BP) monitor thresholds (ie, 24-hour mean systolic BP <125 mm Hg and diastolic BP ≥75 mm Hg). We analyzed data from 11 135 participants in the IDACO (International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes). Using 24-hour mean ambulatory BP monitor values, we performed Cox regression testing independent associations of IDH with death or cardiovascular events. Analyses were conducted in the cohort overall, as well as after age stratification (<50 years versus ≥50 years). The median age at baseline was 54.7 years and 49% were female. Over a median follow-up of 13.8 years, 2836 participants died, and 2049 experienced a cardiovascular event. Overall, irrespective of age, IDH on 24-hour ambulatory BP monitor defined by 2017 American College of Cardiology/American Heart Association criteria was not significantly associated with death (hazard ratio, 0.95 [95% CI, 0.79–1.13]) or cardiovascular events (hazard ratio, 1.14 [95% CI, 0.94–1.40]), compared with normotension. However, among the subgroup <50 years old, IDH was associated with excess risk for cardiovascular events (2.87 [95% CI, 1.72–4.80]), with evidence for effect modification based on age ( P interaction <0.001). In conclusion, using ambulatory BP monitor data, this study suggests that IDH defined by 2017 American College of Cardiology/American Heart Association criteria is not a risk factor for cardiovascular disease in adults aged 50 years or older but is a risk factor among younger adults. Thus, age is an important consideration in the clinical management of adults with IDH.