期刊
HYPERTENSION
卷 78, 期 5, 页码 1222-1231出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/HYPERTENSIONAHA.121.17766
关键词
blood pressure; hypertension; morbidity; mortality; risk
资金
- Belgium: European Union [HEALTH-F7-305507 HOMAGE]
- European Research Council [2011-294713-EPLORE, 713601-uPROPHET]
- European Research Area Net for Cardiovascular Diseases [JTC2017-046-PROACT]
- Research Foundation Flanders, Ministry of the Flemish Community, Brussels, Belgium [G.0881.13]
- China: National Natural Science Foundation of China [81170245, 81270373, 81470533, 91639203]
- Ministry of Science and Technology, Beijing, China [2013CB530700]
- Ministry of Science and Technology, Beijing, China (China-European Union Collaboration Grant) [1012]
- Shanghai Commissions of Science and Technology [14ZR1436200, 15XD1503200]
- Shanghai Commissions of Science and Technology (Shanghai Pujiang Program) [20PJ1412700]
- Education (Gaofeng Clinical Medicine Grant) [20152503]
- Czech Republic: European Union [LSHM-CT-2006-037093, HEALTH-F4-2007-201550]
- Charles University
- Denmark: Danish Heart Foundation [01-2-9-9A-22914]
- Lundbeck Fonden [R32-A2740]
- Ireland: Irish Allied Bank
- Italy: European Union [LSHM-CT-2006-037093, HEALTH-F4-2007-201550]
- Japan: Ministry of Culture, Sports, Science and Technology [17H04126, 17K15853, 17K19930, 18K09674, 18K09904, 18K17396, 19K19466, 19H03908, 19K10662, 20K08612]
- ACRO Incubation Grants of Teikyo University
- Japan Atherosclerosis Prevention Fund
- Ministry of Health, Labor and Welfare [H29-Junkankitou-Ippan-003, 20FA1002]
- Academic Contributions from Pfizer Japan, Inc.
- Chugai Pharmaceutical, Co, Ltd.
- Daiichi Sankyo Company
- Astellas Pharma, Inc.
- Takeda Pharmaceutical, Co, Ltd.
- Health Care Science Institute Research Grant
- Health Science Center Research Grant
- Takeda Science Foundation
- Poland (Gdansk): European Union [LSHM-CT-2006-037093, HEALTH-F4-2007-201550]
- Poland (Krakow): European Union [LSHM-CT-2006-037093, HEALTH-F4-2007-201550]
- Foundation for Polish Science
- Russian Federation: European Union [LSHM-CT-2006-037093, HEALTH-F4-2007-201550]
- Russian Academy of Science [AAAA-A17-117112850280-2]
- Uruguay: Asociacion Espanola Primera en Salud
- Venezuela: The National Institute of Aging
- Fogarty International Center [1-R01AG036469 A1]
- National Institutes of Health and National Institute of Aging [1 R03 AG054186-01]
- FONACIT, Caracas [G-97000726]
- FundaConCiencia, Maracibo [LOCTI/008-2008]
- OMRON Healthcare, Co, Ltd, Kyoto, Japan
- Grants-in-Aid for Scientific Research [20K08612, 19H03908, 19K10662, 19K19466, 18K09904, 17K19930, 18K09674, 18K17396, 17K15853, 17H04126] Funding Source: KAKEN
Using ambulatory blood pressure monitor data, the study suggests that isolated diastolic hypertension defined by 2017 ACC/AHA criteria is not a risk factor for cardiovascular disease in adults aged 50 years or older but is a risk factor among younger adults. Age is an important consideration in the clinical management of adults with isolated diastolic hypertension.
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.
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