Reference Values for 24-Hour Ambulatory Blood Pressure Monitoring Based on a Prognostic Criterion

• DOI: 10.1161/01.hyp.32.2.255
• Publication Date: 2012-06-12T00:53:46Z
• Authors: Takayoshi Ohkubo; Yutaka Imai; Ichiro Tsuji; Kenichi Nagai; Sadayoshi Ito; Hiroshi Satoh; Shigeru Hisamichi
• Keywords: Adult; Male; Blood Pressure Monitoring, Ambulatory; Middle Aged; Prognosis; 3. Good health; Cohort Studies; 03 medical and health sciences; 0302 clinical medicine; Japan; Reference Values; Hypertension; Humans; Female; Prospective Studies

Abstract —Although reference values for ambulatory blood pressure (ABP) monitoring have been investigated in several population studies, these values were derived from cross-sectional observations and were based merely on the statistical distribution of blood pressure values. Therefore, we conducted a prospective cohort study to identify reference values for 24-hour ABP in relation to prognosis. We obtained measurements of 24-hour ABP for 1542 subjects (565 men) aged 40 years and over in a general population of a rural Japanese community and then followed-up their survival status. There were 117 deaths during the follow-up period (mean, 6.2 years). The association between baseline 24-hour ABP values and mortality, examined by the Cox proportional hazards regression model adjusted for possible confounding factors, showed a better fit with a second-degree equation than with a first-degree equation. On the basis of the results of this analysis, we identified the following reference values as the optimal blood pressure ranges that predict the best prognosis: 120 to 133 mm Hg for systolic blood pressure and 65 to 78 mm Hg for diastolic blood pressure. 24-Hour ABP values >134/79 mm Hg and <119/64 mm Hg were related to increased risks for cardiovascular and noncardiovascular mortality, respectively. This is the first report to propose reference values for 24-hour ABP based on a prognostic criterion.