Definition of ambulatory blood pressure targets for diagnosis and treatment of hypertension in relation to clinic blood pressure

Geoffrey A Head, Anastasia S Mihailidou, Karen A Duggan, Lawrence J Beilin, Narelle Berry, Mark Brown, Alex J Bune, Diane Cowley, John P Chalmers, Peter R C Howe, Jonathan Hodgson, John Ludbrook, Arduino Aleksander 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

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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.
Original languageEnglish
Pages (from-to)c1104
JournalBMJ Rapid Response
Volume340
DOIs
Publication statusPublished - 14 Apr 2010

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Blood Pressure
Hypertension
Therapeutics
Body Mass Index
Equipment and Supplies

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Head, G. A., Mihailidou, A. S., Duggan, K. A., Beilin, L. J., Berry, N., Brown, M., ... Ambulatory Blood Pressure Working Group of the High Blood Pressure Research Council of Australia (2010). Definition of ambulatory blood pressure targets for diagnosis and treatment of hypertension in relation to clinic blood pressure. BMJ Rapid Response, 340, c1104. https://doi.org/10.1136/bmj.c1104

Definition of ambulatory blood pressure targets for diagnosis and treatment of hypertension in relation to clinic blood pressure. / Head, Geoffrey A; Mihailidou, Anastasia S; Duggan, Karen A; Beilin, Lawrence J; Berry, Narelle; Brown, Mark; Bune, Alex J; Cowley, Diane; Chalmers, John P; Howe, Peter R C; Hodgson, Jonathan; Ludbrook, John; Mangoni, Arduino Aleksander; McGrath, Barry P; Nelson, Mark R; Sharman, James E; Stowasser, Michael; Ambulatory Blood Pressure Working Group of the High Blood Pressure Research Council of Australia.

In: BMJ Rapid Response, Vol. 340, 14.04.2010, p. c1104.

Research output: Contribution to journalArticle

Head, GA, Mihailidou, AS, Duggan, KA, Beilin, LJ, Berry, N, Brown, M, Bune, AJ, Cowley, D, Chalmers, JP, Howe, PRC, Hodgson, J, Ludbrook, J, Mangoni, AA, McGrath, BP, Nelson, MR, Sharman, JE, Stowasser, M & Ambulatory Blood Pressure Working Group of the High Blood Pressure Research Council of Australia 2010, 'Definition of ambulatory blood pressure targets for diagnosis and treatment of hypertension in relation to clinic blood pressure', BMJ Rapid Response, vol. 340, pp. c1104. https://doi.org/10.1136/bmj.c1104
Head, Geoffrey A ; Mihailidou, Anastasia S ; Duggan, Karen A ; Beilin, Lawrence J ; Berry, Narelle ; Brown, Mark ; Bune, Alex J ; Cowley, Diane ; Chalmers, John P ; Howe, Peter R C ; Hodgson, Jonathan ; Ludbrook, John ; Mangoni, Arduino Aleksander ; McGrath, Barry P ; Nelson, Mark R ; Sharman, James E ; Stowasser, Michael ; Ambulatory Blood Pressure Working Group of the High Blood Pressure Research Council of Australia. / Definition of ambulatory blood pressure targets for diagnosis and treatment of hypertension in relation to clinic blood pressure. In: BMJ Rapid Response. 2010 ; Vol. 340. pp. c1104.
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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.",
author = "Head, {Geoffrey A} and Mihailidou, {Anastasia S} and Duggan, {Karen A} and Beilin, {Lawrence J} and Narelle Berry and Mark Brown and Bune, {Alex J} and Diane Cowley and Chalmers, {John P} and Howe, {Peter R C} and Jonathan Hodgson and John Ludbrook and Mangoni, {Arduino Aleksander} and McGrath, {Barry P} and Nelson, {Mark R} and Sharman, {James E} and Michael Stowasser and {Ambulatory Blood Pressure Working Group of the High Blood Pressure Research Council of Australia}",
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T1 - Definition of ambulatory blood pressure targets for diagnosis and treatment of hypertension in relation to clinic blood pressure

AU - Head, Geoffrey A

AU - Mihailidou, Anastasia S

AU - Duggan, Karen A

AU - Beilin, Lawrence J

AU - Berry, Narelle

AU - Brown, Mark

AU - Bune, Alex J

AU - Cowley, Diane

AU - Chalmers, John P

AU - Howe, Peter R C

AU - Hodgson, Jonathan

AU - Ludbrook, John

AU - Mangoni, Arduino Aleksander

AU - McGrath, Barry P

AU - Nelson, Mark R

AU - Sharman, James E

AU - Stowasser, Michael

AU - Ambulatory Blood Pressure Working Group of the High Blood Pressure Research Council of Australia

PY - 2010/4/14

Y1 - 2010/4/14

N2 - 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.

AB - 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.

U2 - 10.1136/bmj.c1104

DO - 10.1136/bmj.c1104

M3 - Article

VL - 340

SP - c1104

JO - BMJ

JF - BMJ

SN - 0959-8146

ER -