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Interplay of Age and Sex With Clinic and Ambulatory Blood Pressure and Mortality
Michael Böhm1, Alejandro de la Sierra2, Igor Schwantke1
1HOMICAREM (HOMburg Institute for CArdioREnalMetabolic Medicine) and Department of Internal Medicine III, Cardiology, Angiology, Intensive Care Medicine, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany (M.B., I.S., B.H., M.T., F.M., L.L.).
Insights
Ambulatory blood pressure monitoring (ABPM) is a better predictor of cardiovascular death (CVD) risk than traditional office BP measurements. Nighttime BP and pulse pressure are key indicators, especially in older women.
Area of Science:
- Cardiology
- Hypertension Research
- Preventive Medicine
Background:
- Large cohort study in primary care exploring associations between clinic and 24-hour ambulatory blood pressure monitoring (ABPM) and cardiovascular death (CVD).
- Utilized data from the Spanish ABPM Registry, including mortality, age, sex, and comprehensive ABPM parameters for 59,124 patients.
Purpose of the Study:
- To investigate the relationship between various blood pressure (BP) parameters measured by clinic and ABPM and the risk of cardiovascular death (CVD).
- To model these associations by age and sex, identifying potential differences and trajectories.
Main Methods:
- Modeled office, mean 24-hour, daytime, and nighttime systolic BP (SBP), diastolic BP, and pulse pressure (PP) against CVD risk.
- Employed restricted cubic splines to visualize BP trajectories across age and sex.
- Followed 59,124 patients for a median of 9.7 years, documenting 2361 CVD events.
Main Results:
- Observed nonlinear relationships between SBP, diastolic BP, PP, and CVD risk for both sexes.
- High SBP and PP are associated with CVD risk irrespective of sex or age.
- Nighttime BP and PP showed a closer association with CVD risk than office BP, particularly in younger individuals.
Conclusions:
- Twenty-four-hour mean and nighttime BP, along with PP, are significant predictors of CVD risk, with heightened risk in elderly females.
- ABPM, especially nighttime BP, offers superior risk prediction compared to office BP, particularly in younger populations.
- Guidelines should emphasize the use of 24-hour ABPM data for comprehensive cardiovascular risk assessment.
Background:
To explore associations of clinic and 24-hour ambulatory blood pressure (BP) monitoring (ABPM) with cardiovascular death (CVD), parameters were modeled for age and sex in this large cohort in primary care.
Methods:
In the Spanish ABPM Registry, 59.124 patients had complete data on mortality, age, sex, and all ABPM. Office, mean, 24-hour, daytime, and nighttime systolic BP (SBP), diastolic BP, and pulse pressure (PP) were related to CVD according to age and sex and were modelled with restricted cubic splines to get trajectories. During a median of 9.7 years, 2361 patients had CVD (1229 males, 1132 females).
Results:
Nonlinear relationships for office, 24-hour mean, daytime, and nighttime SBP, diastolic BP, and PP (P<0.0001 for all) for both sexes were observed. Until 75 years, SBP was higher in males than females, but differences were minimized after ≈60 to 70 years (P for interaction <0.0001). High SBP and PP are associated with CVD without heterogeneity between sexes and across aging. The increase of SBP and PP was higher at a higher age for females than males (P for interaction <0.0001). CVD was age-dependent, and ABPM, in particular nighttime BP did more closely associated with risk than office BP in younger than in older individuals.
Conclusions:
Twenty-four-hour mean, nighttime BP, and PP were closely associated with risk being higher in elderly females than males after 75 years, corresponding to a rise in BP in older females. Guidelines should continue to mandate the evaluation of 24-hour ABPM data for risk prediction.
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