Journal Article


Jan A Staessen
Eoin O'Brien
Jiguang Wang
Yutaka Imai
Jan Filipovsky
Kalina Kawecka-Jaszcz
Edgardo Sandoya
Lars Lind
Yuri Nikitin
Edoardo Casiglia
and 18 others


Medicine & Nursing

masked hypertension cohort studies prehypertension epidemiology asia south america male stroke physiopathology physiology humans middle aged adult europe etiology blood pressure monitoring ambulatory hypertension female blood pressure determination blood pressure cardiovascular diseases diagnosis

Risk stratification by ambulatory blood pressure monitoring across JNC classes of conventional blood pressure. (2014)

Abstract Guidelines propose classification of conventional blood pressure (CBP) into normotension (<120/<80 mm Hg), prehypertension (120-139/80-89 mm Hg), and hypertension (≥140/≥90 mm Hg). To assess the potential differential contribution of ambulatory blood pressure (ABP) in predicting risk across CBP strata, we analyzed outcomes in 7,826 untreated people recruited from 11 populations. During an 11.3-year period, 809 participants died (276 cardiovascular deaths) and 639, 383, and 225 experienced a cardiovascular, cardiac, or cerebrovascular event. Compared with normotension (n = 2,639), prehypertension (n = 3,076) carried higher risk (P ≤ 0.015) of cardiovascular (+41%) and cerebrovascular (+92%) endpoints; compared with hypertension (n = 2,111) prehypertension entailed lower risk (P ≤ 0.005) of total mortality (-14%) and cardiovascular mortality (-29%) and of cardiovascular (-34%), cardiac (-33%), or cerebrovascular (-47%) events. Multivariable-adjusted hazard ratios (HRs) for stroke associated with 24-hour and daytime diastolic ABP (+5 mm Hg) were higher (P ≤ 0.045) in normotension than in prehypertension and hypertension (1.98 vs.1.19 vs.1.28 and 1.73 vs.1.09 vs. 1.24, respectively) with similar trends (0.03 ≤ P ≤ 0.11) for systolic ABP (+10 mm Hg). However, HRs for fatal endpoints and cardiac events associated with ABP did not differ significantly (P ≥ 0.13) across CBP categories. Of normotensive and prehypertensive participants, 7.5% and 29.3% had masked hypertension (daytime ABP ≥135/≥85 mm Hg). Compared with true normotension (P ≤ 0.01), HRs for stroke were 3.02 in normotension and 2.97 in prehypertension associated with masked hypertension with no difference between the latter two conditions (P = 0.93). ABP refines risk stratification in normotension and prehypertension mainly by enabling the diagnosis of masked hypertension.
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Full list of authors on original publication

Jan A Staessen, Eoin O'Brien, Jiguang Wang, Yutaka Imai, Jan Filipovsky, Kalina Kawecka-Jaszcz, Edgardo Sandoya, Lars Lind, Yuri Nikitin, Edoardo Casiglia and 18 others

Experts in our system

Jan A Staessen
University College Dublin
Total Publications: 11
Eoin O'Brien
University College Dublin
Total Publications: 75
Jiguang Wang
University College Dublin