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Age-specific differences between conventional and ambulatory daytime blood pressure values
David Conen1, Stefanie Aeschbacher1, Lutgarde Thijs1
1From the Cardiovascular Research Institut Basel and Department of Medicine, University Hospital Basel, Basel, Switzerland (D.C., S.A., T.S.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., K.A., Y.-M.G., T.K., J.A.S.); Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L., J.-G.W.); Centro de Nefrologìa and Departamento de Fisiopatologìa, Hospital de Clìnicas, Universidad de la Repûblica, Montevideo, Uruguay (J.B.); Steno Diabetes Center, Gentofte and Research Center for Prevention and Health, Gentofte, Denmark (T.W.H.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.K., T.O., Y.I.); Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden (K.B.-B.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark (J.J.); Department of Health, Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); Cambridge University Hospitals, Addenbrook's Hospital, Cambridge, United Kingdom (E.D.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakòw, Poland (K.S.-S., K.K.-J.); Department of Medicine, University of Padova, Padova, Italy (V.T., E.C.); Institute of Internal Medicine, Novosibirsk, Russian Federation (S.M., Y.N.); Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden (L.L.); Asoci
Insights
Daytime ambulatory blood pressure (BP) differs from conventional BP, especially in younger adults where daytime BP is higher. This large study reveals age-related differences in BP measurement, impacting hypertension diagnosis.
Area of Science:
- Cardiology
- Hypertension Research
- Ambulatory Blood Pressure Monitoring
Background:
- Conventional blood pressure (BP) values are typically considered higher than daytime ambulatory BP.
- Limited data exist on this relationship in individuals under 50 years old.
- Understanding these differences is crucial for accurate hypertension diagnosis across age groups.
Purpose of the Study:
- To investigate the relationship between daytime ambulatory BP and conventional BP across different age categories.
- To determine age-specific prevalences of white-coat hypertension and masked hypertension.
- To provide insights for clinical practice in diagnosing hypertension and its subtypes.
Main Methods:
- Analysis of conventional and 24-hour ambulatory BP data from 9550 individuals not on antihypertensive treatment.
- Comparison of BP differences between daytime ambulatory and conventional measurements stratified by 10-year age categories.
- Calculation of age-specific prevalences for white-coat and masked hypertension.
Main Results:
- In younger adults (18-50 years), mean daytime BP was significantly higher than conventional BP (systolic: 4.7–6.0 mm Hg; diastolic: 1.7–2.7 mm Hg).
- In older adults (≥60 years), conventional BP was significantly higher than daytime ambulatory BP (systolic: 5.0–13.0 mm Hg; diastolic: 2.0–4.2 mm Hg).
- White-coat hypertension prevalence increased with age (2.2% to 19.5%), while masked hypertension was more common in men (21.1% vs. 11.4%).
Conclusions:
- The relationship between daytime ambulatory BP and conventional BP is strongly age-dependent.
- Age significantly influences the prevalence of white-coat and masked hypertension.
- These findings have important implications for the accurate diagnosis and management of hypertension in clinical practice.
Abstract:
Mean daytime ambulatory blood pressure (BP) values are considered to be lower than conventional BP values, but data on this relation among younger individuals <50 years are scarce. Conventional and 24-hour ambulatory BP were measured in 9550 individuals not taking antihypertensive treatment from 13 population-based cohorts. We compared individual differences between daytime ambulatory and conventional BP according to 10-year age categories. Age-specific prevalences of white coat and masked hypertension were calculated. Among individuals aged 18 to 30, 30 to 40, and 40 to 50 years, mean daytime BP was significantly higher than the corresponding conventional BP (6.0, 5.2, and 4.7 mm Hg for systolic; 2.5, 2.7, and 1.7 mm Hg for diastolic BP; all P<0.0001). In individuals aged 60 to 70 and ≥70 years, conventional BP was significantly higher than daytime ambulatory BP (5.0 and 13.0 mm Hg for systolic; 2.0 and 4.2 mm Hg for diastolic BP; all P<0.0001).The prevalence of white coat hypertension exponentially increased from 2.2% to 19.5% from those aged 18 to 30 years to those aged ≥70 years, with little variation between men and women (8.0% versus 6.1%; P=0.0003). Masked hypertension was more prevalent among men (21.1% versus 11.4%; P<0.0001). The age-specific prevalences of masked hypertension were 18.2%, 27.3%, 27.8%, 20.1%, 13.6%, and 10.2% among men and 9.0%, 9.9%, 12.2%, 11.9%, 14.7%, and 12.1% among women. In conclusion, this large collaborative analysis showed that the relation between daytime ambulatory and conventional BP strongly varies by age. These findings may have implications for diagnosing hypertension and its subtypes in clinical practice.
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