Prehypertension mdash a stage to think about

kliničnioddelek za

hipertenzijo

Greece 2017

Jana Brguljan MD PhD FESC

University Medical Centre LjubljanaHypertension DepartmentHospital drPDržaj

GBD 2013 Risk Factors Collaborators Lancet Published online September 11 2015

2000 2013

Global DALYs attributed to level 2 risk factors in 2000 and in 2013

When did story begin

bull Probably in 1939 Robinson and Brucer defined BPs in the range of 120-13980-89mmHg as prehypertensive (Robinson SC Brucer M Arch Inter Med 1939 64409-444)

bull 1999 Frolich reported that BP lt 14090mmHg is associated with increased risk for CV disease stroke nad premature death (Frolich ED J Am Coll Cardiol 1999)

When did story begin

Definition of prehypertension and high normal blood pressure

bull The USA Joint National Committee Guidelines (JNC 7) on hypertension published in 2003 unified the normal and high normal blood pressure categories into a single entity termed lsquolsquoprehypertensionrsquorsquo(120-13980-89mmHg)

bull The ESH ESC Committee 2013 has decided not to use this terminologydue to several resones and defined high normal blood pressure

Definitions and classification of blood pressure levels(mmHg)

Category Systolic DiastolicOptimal lt120 and lt80Normal 120ndash129 andor 80ndash84High normal 130ndash139 andor 85ndash89Hypertension gt140 andor gt90

Mortality from ischemic heart disease and stroke increases with increasing blood pressrue

Prospective Studies Collaboration Lancet 20023601903-13

stroke

Ishemic heart disease

Prospective Studies Collaboration Lancet 20023601903-13

Framingham Heart Study (n=6859)

Cumulative Incidence of Cardiovascular Events in Women (Panel A) and Men (Panel B) without

Hypertension According to Blood-Pressure Category at the Base-Line Examination

Vasan Larson et all IMPACT OF HIGH-NORMAL BLOOD PRESSURE ON THE RISK OF CARDIOVASCULAR DISEASE N Engl J Med 2001

Vertical bars indicate 95 percent confidence intervals Optimal blood pressure is a systolic pressure of less than 120 mm Hg and a diastolic pressure of less than 80 mm Hg Normal blood pressure is a systolic pressure of 120 to 129 mm Hg or a diastolic pressure of 80 to 84 mm Hg High-normal blood pressure is a systolic pressure of 130 to 139 mm Hg or a diastolic pressure of 85 to 89 mm Hg If the systolic and diastolic pressure readings for a subject were in different categories the higher of the two categories was used

Prevalence of prehypertension ( 40)bull De Marco M de Simone G Roman MJ Chinali M Lee ET Russell M Howard BV Devereux RBCardiovascular and metabolic

predictors of progression of prehypertension into hypertension the Strong Heart Study Hypertension 2009 Nov54(5)974-80 Epub 2009 Aug 31Strong Heart Study 625 American Indian 45-74y

22 of prevalence of pht 53 among diabetics 33 among non-diabeticHigher BMI SBP DBP pp HR diabetes TG fibrinogen CRP lower HDL higher LVM

bull Zhang Y Lee ET Devereux RB Yeh J Best LG Fabsitz RR Howard BV Prehypertension diabetes and cardiovascular disease risk in a population based sample the Strong Heart Study

Hypertension 2006 Mar47(3)410-4 Epub 2006 Jan 30 Strong Heart Study1532 no diabetic and 1097 diabetics American Indian 55 +-8y

Prevalence of prehypert 594 in diabetics and 482 in non diabeticsIn all age groups from 45-49 to 70-74 diabetics had higher prevalence than non-diabetic and

Kaplan Meier plots showed that prehyperte had higher CV disease incidence and when diabetes was added it was even higher

Only prehypertension was lower than diabetes itself

bull Mainous AG 3rd Everett CJ Liszka H King DE Egan BMPrehypertension and mortality in a nationally representative cohortAm J Cardiol 2004 Dec 1594(12)1496-500NHAES IIstart NH2MS followed 9087 USA 30-74y

31prevalence of pht 37hypertension

bull Liszka HA Mainous AG III King DEEverett CJ Egan BM Prehypertension and cardiovascular morbidity Ann Fam Med 20053294-9NHAES 8986Usa 86white

33prevalence of pht47hypertension

World Hypertension Day Slovenija 2016

(n=2651)

Huang et all Neurology 2014

Prevalenca of prehypertension

Prevalence of prehypertension and hypertension stratified by sex and age

Hu L Huang X You C Li J Hong K et al (2017) Prevalence and Risk Factors of Prehypertension and Hypertension in Southern China PLOS ONE 12(1) e0170238 doi101371journalpone0170238httpjournalsplosorgplosonearticleid=101371journalpone0170238

PLOS 2017

GBD 2013 Risk Factors Collaborators Lancet Published online September 11 2015

2000 2013

Global DALYs attributed to level 2 risk factors in 2000 and in 2013

When did story begin

bull Probably in 1939 Robinson and Brucer defined BPs in the range of 120-13980-89mmHg as prehypertensive (Robinson SC Brucer M Arch Inter Med 1939 64409-444)

bull 1999 Frolich reported that BP lt 14090mmHg is associated with increased risk for CV disease stroke nad premature death (Frolich ED J Am Coll Cardiol 1999)

When did story begin

Definition of prehypertension and high normal blood pressure

bull The USA Joint National Committee Guidelines (JNC 7) on hypertension published in 2003 unified the normal and high normal blood pressure categories into a single entity termed lsquolsquoprehypertensionrsquorsquo(120-13980-89mmHg)

bull The ESH ESC Committee 2013 has decided not to use this terminologydue to several resones and defined high normal blood pressure

Definitions and classification of blood pressure levels(mmHg)

Category Systolic DiastolicOptimal lt120 and lt80Normal 120ndash129 andor 80ndash84High normal 130ndash139 andor 85ndash89Hypertension gt140 andor gt90

Mortality from ischemic heart disease and stroke increases with increasing blood pressrue

Prospective Studies Collaboration Lancet 20023601903-13

stroke

Ishemic heart disease

Prospective Studies Collaboration Lancet 20023601903-13

Framingham Heart Study (n=6859)

Cumulative Incidence of Cardiovascular Events in Women (Panel A) and Men (Panel B) without

Hypertension According to Blood-Pressure Category at the Base-Line Examination

Vasan Larson et all IMPACT OF HIGH-NORMAL BLOOD PRESSURE ON THE RISK OF CARDIOVASCULAR DISEASE N Engl J Med 2001

Vertical bars indicate 95 percent confidence intervals Optimal blood pressure is a systolic pressure of less than 120 mm Hg and a diastolic pressure of less than 80 mm Hg Normal blood pressure is a systolic pressure of 120 to 129 mm Hg or a diastolic pressure of 80 to 84 mm Hg High-normal blood pressure is a systolic pressure of 130 to 139 mm Hg or a diastolic pressure of 85 to 89 mm Hg If the systolic and diastolic pressure readings for a subject were in different categories the higher of the two categories was used

Prevalence of prehypertension ( 40)bull De Marco M de Simone G Roman MJ Chinali M Lee ET Russell M Howard BV Devereux RBCardiovascular and metabolic

predictors of progression of prehypertension into hypertension the Strong Heart Study Hypertension 2009 Nov54(5)974-80 Epub 2009 Aug 31Strong Heart Study 625 American Indian 45-74y

22 of prevalence of pht 53 among diabetics 33 among non-diabeticHigher BMI SBP DBP pp HR diabetes TG fibrinogen CRP lower HDL higher LVM

bull Zhang Y Lee ET Devereux RB Yeh J Best LG Fabsitz RR Howard BV Prehypertension diabetes and cardiovascular disease risk in a population based sample the Strong Heart Study

Hypertension 2006 Mar47(3)410-4 Epub 2006 Jan 30 Strong Heart Study1532 no diabetic and 1097 diabetics American Indian 55 +-8y

Prevalence of prehypert 594 in diabetics and 482 in non diabeticsIn all age groups from 45-49 to 70-74 diabetics had higher prevalence than non-diabetic and

Kaplan Meier plots showed that prehyperte had higher CV disease incidence and when diabetes was added it was even higher

Only prehypertension was lower than diabetes itself

bull Mainous AG 3rd Everett CJ Liszka H King DE Egan BMPrehypertension and mortality in a nationally representative cohortAm J Cardiol 2004 Dec 1594(12)1496-500NHAES IIstart NH2MS followed 9087 USA 30-74y

31prevalence of pht 37hypertension

bull Liszka HA Mainous AG III King DEEverett CJ Egan BM Prehypertension and cardiovascular morbidity Ann Fam Med 20053294-9NHAES 8986Usa 86white

33prevalence of pht47hypertension

World Hypertension Day Slovenija 2016

(n=2651)

Huang et all Neurology 2014

Prevalenca of prehypertension

Prevalence of prehypertension and hypertension stratified by sex and age

Hu L Huang X You C Li J Hong K et al (2017) Prevalence and Risk Factors of Prehypertension and Hypertension in Southern China PLOS ONE 12(1) e0170238 doi101371journalpone0170238httpjournalsplosorgplosonearticleid=101371journalpone0170238

PLOS 2017

When did story begin

bull Probably in 1939 Robinson and Brucer defined BPs in the range of 120-13980-89mmHg as prehypertensive (Robinson SC Brucer M Arch Inter Med 1939 64409-444)

bull 1999 Frolich reported that BP lt 14090mmHg is associated with increased risk for CV disease stroke nad premature death (Frolich ED J Am Coll Cardiol 1999)

When did story begin

Definition of prehypertension and high normal blood pressure

bull The USA Joint National Committee Guidelines (JNC 7) on hypertension published in 2003 unified the normal and high normal blood pressure categories into a single entity termed lsquolsquoprehypertensionrsquorsquo(120-13980-89mmHg)

bull The ESH ESC Committee 2013 has decided not to use this terminologydue to several resones and defined high normal blood pressure

Definitions and classification of blood pressure levels(mmHg)

Category Systolic DiastolicOptimal lt120 and lt80Normal 120ndash129 andor 80ndash84High normal 130ndash139 andor 85ndash89Hypertension gt140 andor gt90

Mortality from ischemic heart disease and stroke increases with increasing blood pressrue

Prospective Studies Collaboration Lancet 20023601903-13

stroke

Ishemic heart disease

Prospective Studies Collaboration Lancet 20023601903-13

Framingham Heart Study (n=6859)

Cumulative Incidence of Cardiovascular Events in Women (Panel A) and Men (Panel B) without

Hypertension According to Blood-Pressure Category at the Base-Line Examination

Vasan Larson et all IMPACT OF HIGH-NORMAL BLOOD PRESSURE ON THE RISK OF CARDIOVASCULAR DISEASE N Engl J Med 2001

Vertical bars indicate 95 percent confidence intervals Optimal blood pressure is a systolic pressure of less than 120 mm Hg and a diastolic pressure of less than 80 mm Hg Normal blood pressure is a systolic pressure of 120 to 129 mm Hg or a diastolic pressure of 80 to 84 mm Hg High-normal blood pressure is a systolic pressure of 130 to 139 mm Hg or a diastolic pressure of 85 to 89 mm Hg If the systolic and diastolic pressure readings for a subject were in different categories the higher of the two categories was used

Prevalence of prehypertension ( 40)bull De Marco M de Simone G Roman MJ Chinali M Lee ET Russell M Howard BV Devereux RBCardiovascular and metabolic

predictors of progression of prehypertension into hypertension the Strong Heart Study Hypertension 2009 Nov54(5)974-80 Epub 2009 Aug 31Strong Heart Study 625 American Indian 45-74y

22 of prevalence of pht 53 among diabetics 33 among non-diabeticHigher BMI SBP DBP pp HR diabetes TG fibrinogen CRP lower HDL higher LVM

bull Zhang Y Lee ET Devereux RB Yeh J Best LG Fabsitz RR Howard BV Prehypertension diabetes and cardiovascular disease risk in a population based sample the Strong Heart Study

Hypertension 2006 Mar47(3)410-4 Epub 2006 Jan 30 Strong Heart Study1532 no diabetic and 1097 diabetics American Indian 55 +-8y

Prevalence of prehypert 594 in diabetics and 482 in non diabeticsIn all age groups from 45-49 to 70-74 diabetics had higher prevalence than non-diabetic and

Kaplan Meier plots showed that prehyperte had higher CV disease incidence and when diabetes was added it was even higher

Only prehypertension was lower than diabetes itself

bull Mainous AG 3rd Everett CJ Liszka H King DE Egan BMPrehypertension and mortality in a nationally representative cohortAm J Cardiol 2004 Dec 1594(12)1496-500NHAES IIstart NH2MS followed 9087 USA 30-74y

31prevalence of pht 37hypertension

bull Liszka HA Mainous AG III King DEEverett CJ Egan BM Prehypertension and cardiovascular morbidity Ann Fam Med 20053294-9NHAES 8986Usa 86white

33prevalence of pht47hypertension

World Hypertension Day Slovenija 2016

(n=2651)

Huang et all Neurology 2014

Prevalenca of prehypertension

Prevalence of prehypertension and hypertension stratified by sex and age

Hu L Huang X You C Li J Hong K et al (2017) Prevalence and Risk Factors of Prehypertension and Hypertension in Southern China PLOS ONE 12(1) e0170238 doi101371journalpone0170238httpjournalsplosorgplosonearticleid=101371journalpone0170238

PLOS 2017

When did story begin

Definition of prehypertension and high normal blood pressure

bull The USA Joint National Committee Guidelines (JNC 7) on hypertension published in 2003 unified the normal and high normal blood pressure categories into a single entity termed lsquolsquoprehypertensionrsquorsquo(120-13980-89mmHg)

bull The ESH ESC Committee 2013 has decided not to use this terminologydue to several resones and defined high normal blood pressure

Definitions and classification of blood pressure levels(mmHg)

Category Systolic DiastolicOptimal lt120 and lt80Normal 120ndash129 andor 80ndash84High normal 130ndash139 andor 85ndash89Hypertension gt140 andor gt90

Mortality from ischemic heart disease and stroke increases with increasing blood pressrue

Prospective Studies Collaboration Lancet 20023601903-13

stroke

Ishemic heart disease

Prospective Studies Collaboration Lancet 20023601903-13

Framingham Heart Study (n=6859)

Cumulative Incidence of Cardiovascular Events in Women (Panel A) and Men (Panel B) without

Hypertension According to Blood-Pressure Category at the Base-Line Examination

Vasan Larson et all IMPACT OF HIGH-NORMAL BLOOD PRESSURE ON THE RISK OF CARDIOVASCULAR DISEASE N Engl J Med 2001

Vertical bars indicate 95 percent confidence intervals Optimal blood pressure is a systolic pressure of less than 120 mm Hg and a diastolic pressure of less than 80 mm Hg Normal blood pressure is a systolic pressure of 120 to 129 mm Hg or a diastolic pressure of 80 to 84 mm Hg High-normal blood pressure is a systolic pressure of 130 to 139 mm Hg or a diastolic pressure of 85 to 89 mm Hg If the systolic and diastolic pressure readings for a subject were in different categories the higher of the two categories was used

Prevalence of prehypertension ( 40)bull De Marco M de Simone G Roman MJ Chinali M Lee ET Russell M Howard BV Devereux RBCardiovascular and metabolic

predictors of progression of prehypertension into hypertension the Strong Heart Study Hypertension 2009 Nov54(5)974-80 Epub 2009 Aug 31Strong Heart Study 625 American Indian 45-74y

22 of prevalence of pht 53 among diabetics 33 among non-diabeticHigher BMI SBP DBP pp HR diabetes TG fibrinogen CRP lower HDL higher LVM

bull Zhang Y Lee ET Devereux RB Yeh J Best LG Fabsitz RR Howard BV Prehypertension diabetes and cardiovascular disease risk in a population based sample the Strong Heart Study

Hypertension 2006 Mar47(3)410-4 Epub 2006 Jan 30 Strong Heart Study1532 no diabetic and 1097 diabetics American Indian 55 +-8y

Prevalence of prehypert 594 in diabetics and 482 in non diabeticsIn all age groups from 45-49 to 70-74 diabetics had higher prevalence than non-diabetic and

Kaplan Meier plots showed that prehyperte had higher CV disease incidence and when diabetes was added it was even higher

Only prehypertension was lower than diabetes itself

bull Mainous AG 3rd Everett CJ Liszka H King DE Egan BMPrehypertension and mortality in a nationally representative cohortAm J Cardiol 2004 Dec 1594(12)1496-500NHAES IIstart NH2MS followed 9087 USA 30-74y

31prevalence of pht 37hypertension

bull Liszka HA Mainous AG III King DEEverett CJ Egan BM Prehypertension and cardiovascular morbidity Ann Fam Med 20053294-9NHAES 8986Usa 86white

33prevalence of pht47hypertension

World Hypertension Day Slovenija 2016

(n=2651)

Huang et all Neurology 2014

Prevalenca of prehypertension

Prevalence of prehypertension and hypertension stratified by sex and age

Hu L Huang X You C Li J Hong K et al (2017) Prevalence and Risk Factors of Prehypertension and Hypertension in Southern China PLOS ONE 12(1) e0170238 doi101371journalpone0170238httpjournalsplosorgplosonearticleid=101371journalpone0170238

PLOS 2017

Definition of prehypertension and high normal blood pressure

bull The USA Joint National Committee Guidelines (JNC 7) on hypertension published in 2003 unified the normal and high normal blood pressure categories into a single entity termed lsquolsquoprehypertensionrsquorsquo(120-13980-89mmHg)

bull The ESH ESC Committee 2013 has decided not to use this terminologydue to several resones and defined high normal blood pressure

Definitions and classification of blood pressure levels(mmHg)

Category Systolic DiastolicOptimal lt120 and lt80Normal 120ndash129 andor 80ndash84High normal 130ndash139 andor 85ndash89Hypertension gt140 andor gt90

Mortality from ischemic heart disease and stroke increases with increasing blood pressrue

Prospective Studies Collaboration Lancet 20023601903-13

stroke

Ishemic heart disease

Prospective Studies Collaboration Lancet 20023601903-13

Framingham Heart Study (n=6859)

Cumulative Incidence of Cardiovascular Events in Women (Panel A) and Men (Panel B) without

Hypertension According to Blood-Pressure Category at the Base-Line Examination

Vasan Larson et all IMPACT OF HIGH-NORMAL BLOOD PRESSURE ON THE RISK OF CARDIOVASCULAR DISEASE N Engl J Med 2001

Vertical bars indicate 95 percent confidence intervals Optimal blood pressure is a systolic pressure of less than 120 mm Hg and a diastolic pressure of less than 80 mm Hg Normal blood pressure is a systolic pressure of 120 to 129 mm Hg or a diastolic pressure of 80 to 84 mm Hg High-normal blood pressure is a systolic pressure of 130 to 139 mm Hg or a diastolic pressure of 85 to 89 mm Hg If the systolic and diastolic pressure readings for a subject were in different categories the higher of the two categories was used

Prevalence of prehypertension ( 40)bull De Marco M de Simone G Roman MJ Chinali M Lee ET Russell M Howard BV Devereux RBCardiovascular and metabolic

predictors of progression of prehypertension into hypertension the Strong Heart Study Hypertension 2009 Nov54(5)974-80 Epub 2009 Aug 31Strong Heart Study 625 American Indian 45-74y

22 of prevalence of pht 53 among diabetics 33 among non-diabeticHigher BMI SBP DBP pp HR diabetes TG fibrinogen CRP lower HDL higher LVM

bull Zhang Y Lee ET Devereux RB Yeh J Best LG Fabsitz RR Howard BV Prehypertension diabetes and cardiovascular disease risk in a population based sample the Strong Heart Study

Hypertension 2006 Mar47(3)410-4 Epub 2006 Jan 30 Strong Heart Study1532 no diabetic and 1097 diabetics American Indian 55 +-8y

Prevalence of prehypert 594 in diabetics and 482 in non diabeticsIn all age groups from 45-49 to 70-74 diabetics had higher prevalence than non-diabetic and

Kaplan Meier plots showed that prehyperte had higher CV disease incidence and when diabetes was added it was even higher

Only prehypertension was lower than diabetes itself

bull Mainous AG 3rd Everett CJ Liszka H King DE Egan BMPrehypertension and mortality in a nationally representative cohortAm J Cardiol 2004 Dec 1594(12)1496-500NHAES IIstart NH2MS followed 9087 USA 30-74y

31prevalence of pht 37hypertension

bull Liszka HA Mainous AG III King DEEverett CJ Egan BM Prehypertension and cardiovascular morbidity Ann Fam Med 20053294-9NHAES 8986Usa 86white

33prevalence of pht47hypertension

World Hypertension Day Slovenija 2016

(n=2651)

Huang et all Neurology 2014

Prevalenca of prehypertension

Prevalence of prehypertension and hypertension stratified by sex and age

Hu L Huang X You C Li J Hong K et al (2017) Prevalence and Risk Factors of Prehypertension and Hypertension in Southern China PLOS ONE 12(1) e0170238 doi101371journalpone0170238httpjournalsplosorgplosonearticleid=101371journalpone0170238

PLOS 2017

Mortality from ischemic heart disease and stroke increases with increasing blood pressrue

Prospective Studies Collaboration Lancet 20023601903-13

stroke

Ishemic heart disease

Prospective Studies Collaboration Lancet 20023601903-13

Framingham Heart Study (n=6859)

Cumulative Incidence of Cardiovascular Events in Women (Panel A) and Men (Panel B) without

Hypertension According to Blood-Pressure Category at the Base-Line Examination

Vasan Larson et all IMPACT OF HIGH-NORMAL BLOOD PRESSURE ON THE RISK OF CARDIOVASCULAR DISEASE N Engl J Med 2001

Vertical bars indicate 95 percent confidence intervals Optimal blood pressure is a systolic pressure of less than 120 mm Hg and a diastolic pressure of less than 80 mm Hg Normal blood pressure is a systolic pressure of 120 to 129 mm Hg or a diastolic pressure of 80 to 84 mm Hg High-normal blood pressure is a systolic pressure of 130 to 139 mm Hg or a diastolic pressure of 85 to 89 mm Hg If the systolic and diastolic pressure readings for a subject were in different categories the higher of the two categories was used

Prevalence of prehypertension ( 40)bull De Marco M de Simone G Roman MJ Chinali M Lee ET Russell M Howard BV Devereux RBCardiovascular and metabolic

predictors of progression of prehypertension into hypertension the Strong Heart Study Hypertension 2009 Nov54(5)974-80 Epub 2009 Aug 31Strong Heart Study 625 American Indian 45-74y

22 of prevalence of pht 53 among diabetics 33 among non-diabeticHigher BMI SBP DBP pp HR diabetes TG fibrinogen CRP lower HDL higher LVM

bull Zhang Y Lee ET Devereux RB Yeh J Best LG Fabsitz RR Howard BV Prehypertension diabetes and cardiovascular disease risk in a population based sample the Strong Heart Study

Hypertension 2006 Mar47(3)410-4 Epub 2006 Jan 30 Strong Heart Study1532 no diabetic and 1097 diabetics American Indian 55 +-8y

Prevalence of prehypert 594 in diabetics and 482 in non diabeticsIn all age groups from 45-49 to 70-74 diabetics had higher prevalence than non-diabetic and

Kaplan Meier plots showed that prehyperte had higher CV disease incidence and when diabetes was added it was even higher

Only prehypertension was lower than diabetes itself

bull Mainous AG 3rd Everett CJ Liszka H King DE Egan BMPrehypertension and mortality in a nationally representative cohortAm J Cardiol 2004 Dec 1594(12)1496-500NHAES IIstart NH2MS followed 9087 USA 30-74y

31prevalence of pht 37hypertension

bull Liszka HA Mainous AG III King DEEverett CJ Egan BM Prehypertension and cardiovascular morbidity Ann Fam Med 20053294-9NHAES 8986Usa 86white

33prevalence of pht47hypertension

World Hypertension Day Slovenija 2016

(n=2651)

Huang et all Neurology 2014

Prevalenca of prehypertension

Prevalence of prehypertension and hypertension stratified by sex and age

Hu L Huang X You C Li J Hong K et al (2017) Prevalence and Risk Factors of Prehypertension and Hypertension in Southern China PLOS ONE 12(1) e0170238 doi101371journalpone0170238httpjournalsplosorgplosonearticleid=101371journalpone0170238

PLOS 2017

Framingham Heart Study (n=6859)

Cumulative Incidence of Cardiovascular Events in Women (Panel A) and Men (Panel B) without

Hypertension According to Blood-Pressure Category at the Base-Line Examination

Vasan Larson et all IMPACT OF HIGH-NORMAL BLOOD PRESSURE ON THE RISK OF CARDIOVASCULAR DISEASE N Engl J Med 2001

Vertical bars indicate 95 percent confidence intervals Optimal blood pressure is a systolic pressure of less than 120 mm Hg and a diastolic pressure of less than 80 mm Hg Normal blood pressure is a systolic pressure of 120 to 129 mm Hg or a diastolic pressure of 80 to 84 mm Hg High-normal blood pressure is a systolic pressure of 130 to 139 mm Hg or a diastolic pressure of 85 to 89 mm Hg If the systolic and diastolic pressure readings for a subject were in different categories the higher of the two categories was used

Prevalence of prehypertension ( 40)bull De Marco M de Simone G Roman MJ Chinali M Lee ET Russell M Howard BV Devereux RBCardiovascular and metabolic

predictors of progression of prehypertension into hypertension the Strong Heart Study Hypertension 2009 Nov54(5)974-80 Epub 2009 Aug 31Strong Heart Study 625 American Indian 45-74y

22 of prevalence of pht 53 among diabetics 33 among non-diabeticHigher BMI SBP DBP pp HR diabetes TG fibrinogen CRP lower HDL higher LVM

bull Zhang Y Lee ET Devereux RB Yeh J Best LG Fabsitz RR Howard BV Prehypertension diabetes and cardiovascular disease risk in a population based sample the Strong Heart Study

Hypertension 2006 Mar47(3)410-4 Epub 2006 Jan 30 Strong Heart Study1532 no diabetic and 1097 diabetics American Indian 55 +-8y

Prevalence of prehypert 594 in diabetics and 482 in non diabeticsIn all age groups from 45-49 to 70-74 diabetics had higher prevalence than non-diabetic and

Kaplan Meier plots showed that prehyperte had higher CV disease incidence and when diabetes was added it was even higher

Only prehypertension was lower than diabetes itself

bull Mainous AG 3rd Everett CJ Liszka H King DE Egan BMPrehypertension and mortality in a nationally representative cohortAm J Cardiol 2004 Dec 1594(12)1496-500NHAES IIstart NH2MS followed 9087 USA 30-74y

31prevalence of pht 37hypertension

bull Liszka HA Mainous AG III King DEEverett CJ Egan BM Prehypertension and cardiovascular morbidity Ann Fam Med 20053294-9NHAES 8986Usa 86white

33prevalence of pht47hypertension

World Hypertension Day Slovenija 2016

(n=2651)

Huang et all Neurology 2014

Prevalenca of prehypertension

Prevalence of prehypertension and hypertension stratified by sex and age

Hu L Huang X You C Li J Hong K et al (2017) Prevalence and Risk Factors of Prehypertension and Hypertension in Southern China PLOS ONE 12(1) e0170238 doi101371journalpone0170238httpjournalsplosorgplosonearticleid=101371journalpone0170238

PLOS 2017

Prevalence of prehypertension ( 40)bull De Marco M de Simone G Roman MJ Chinali M Lee ET Russell M Howard BV Devereux RBCardiovascular and metabolic

predictors of progression of prehypertension into hypertension the Strong Heart Study Hypertension 2009 Nov54(5)974-80 Epub 2009 Aug 31Strong Heart Study 625 American Indian 45-74y

22 of prevalence of pht 53 among diabetics 33 among non-diabeticHigher BMI SBP DBP pp HR diabetes TG fibrinogen CRP lower HDL higher LVM

bull Zhang Y Lee ET Devereux RB Yeh J Best LG Fabsitz RR Howard BV Prehypertension diabetes and cardiovascular disease risk in a population based sample the Strong Heart Study

Hypertension 2006 Mar47(3)410-4 Epub 2006 Jan 30 Strong Heart Study1532 no diabetic and 1097 diabetics American Indian 55 +-8y

Prevalence of prehypert 594 in diabetics and 482 in non diabeticsIn all age groups from 45-49 to 70-74 diabetics had higher prevalence than non-diabetic and

Kaplan Meier plots showed that prehyperte had higher CV disease incidence and when diabetes was added it was even higher

Only prehypertension was lower than diabetes itself

bull Mainous AG 3rd Everett CJ Liszka H King DE Egan BMPrehypertension and mortality in a nationally representative cohortAm J Cardiol 2004 Dec 1594(12)1496-500NHAES IIstart NH2MS followed 9087 USA 30-74y

31prevalence of pht 37hypertension

bull Liszka HA Mainous AG III King DEEverett CJ Egan BM Prehypertension and cardiovascular morbidity Ann Fam Med 20053294-9NHAES 8986Usa 86white

33prevalence of pht47hypertension

World Hypertension Day Slovenija 2016

(n=2651)

Huang et all Neurology 2014

Prevalenca of prehypertension

Prevalence of prehypertension and hypertension stratified by sex and age

Hu L Huang X You C Li J Hong K et al (2017) Prevalence and Risk Factors of Prehypertension and Hypertension in Southern China PLOS ONE 12(1) e0170238 doi101371journalpone0170238httpjournalsplosorgplosonearticleid=101371journalpone0170238

PLOS 2017

World Hypertension Day Slovenija 2016

(n=2651)

Huang et all Neurology 2014

Prevalenca of prehypertension

Prevalence of prehypertension and hypertension stratified by sex and age

Hu L Huang X You C Li J Hong K et al (2017) Prevalence and Risk Factors of Prehypertension and Hypertension in Southern China PLOS ONE 12(1) e0170238 doi101371journalpone0170238httpjournalsplosorgplosonearticleid=101371journalpone0170238

PLOS 2017

Huang et all Neurology 2014

Prevalenca of prehypertension

Prevalence of prehypertension and hypertension stratified by sex and age

Hu L Huang X You C Li J Hong K et al (2017) Prevalence and Risk Factors of Prehypertension and Hypertension in Southern China PLOS ONE 12(1) e0170238 doi101371journalpone0170238httpjournalsplosorgplosonearticleid=101371journalpone0170238

PLOS 2017

Prevalence of prehypertension and hypertension stratified by sex and age

Hu L Huang X You C Li J Hong K et al (2017) Prevalence and Risk Factors of Prehypertension and Hypertension in Southern China PLOS ONE 12(1) e0170238 doi101371journalpone0170238httpjournalsplosorgplosonearticleid=101371journalpone0170238

PLOS 2017

Why is it important

bull Stage by itself or progression to hypertension

SBP (mm Hg) of Total CHD Deaths Pop RR

gt180 72 09

170-179 68 12

160-169 101 27

150-159 195 62

140-149 234 128

130-139 207 228

120-129 99 284

110-119 13 190

lt110 00 61

MRFIT Systolic BP And CHD Mortality Risk Pyramid For Men

Stage 1 429 190 51

Adapted from Stamler et al Arch Intern Med 1993153596

Stage 2 245 46 107

Pre-HTN 306 532 11

Normal 13 251 1

prehypertension was a major unsolved--but soluble--mass public health problem

Prehypertension and stroke risk

Noumerous abnormalities in borderline hypertension according to ProfJulius

bull High cardiac output fast heart rate

bull Abnormal vascular resistance

bull Low plasma volume high hematocrit

bull Several metabolic abnormalities

Age distribution (Slovenia 2009)

0

5

10

15

20

25

30

35

20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-99

Age

Age distribution

Normal BP

New diagnose

HNBP

Hypertension

Risk Factors - Tecumseh BP Study

Normotensive

(n=822) Borderline

(n=124)

p

Cholesterol (mgdL) 176 190 0001

HDL (mgdL) 43 40 001

Triglycerides

(mgdL) 95 135 0001

Insulin (UdL) 12 18 0001

Glucose (mgdL) 92 95 001

Insulin-glucose ratio 0155 0200 0001

Percent overweight 136 301 lt0001

Julius S et al JAMA 1990 264 354-358

Prevalence of prehypertension and hypertension stratified by Visceral Adipose Index and Body Fat Percentage

Hu L Huang X You C Li J Hong K et al (2017) Prevalence and Risk Factors of Prehypertension and Hypertension in Southern China PLOS ONE 12(1) e0170238 doi101371journalpone0170238httpjournalsplosorgplosonearticleid=101371journalpone0170238

PLOS 2017

SBP (mm Hg) of Total CHD Deaths Pop RR

gt180 72 09

170-179 68 12

160-169 101 27

150-159 195 62

140-149 234 128

130-139 207 228

120-129 99 284

110-119 13 190

lt110 00 61

MRFIT Systolic BP And CHD Mortality Risk Pyramid For Men

Stage 1 429 190 51

Adapted from Stamler et al Arch Intern Med 1993153596

Stage 2 245 46 107

Pre-HTN 306 532 11

Normal 13 251 1

prehypertension was a major unsolved--but soluble--mass public health problem

Prehypertension and stroke risk

Noumerous abnormalities in borderline hypertension according to ProfJulius

bull High cardiac output fast heart rate

bull Abnormal vascular resistance

bull Low plasma volume high hematocrit

bull Several metabolic abnormalities

Age distribution (Slovenia 2009)

0

5

10

15

20

25

30

35

20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-99

Age

Age distribution

Normal BP

New diagnose

HNBP

Hypertension

Risk Factors - Tecumseh BP Study

Normotensive

(n=822) Borderline

(n=124)

p

Cholesterol (mgdL) 176 190 0001

HDL (mgdL) 43 40 001

Triglycerides

(mgdL) 95 135 0001

Insulin (UdL) 12 18 0001

Glucose (mgdL) 92 95 001

Insulin-glucose ratio 0155 0200 0001

Percent overweight 136 301 lt0001

Julius S et al JAMA 1990 264 354-358

Prevalence of prehypertension and hypertension stratified by Visceral Adipose Index and Body Fat Percentage

Hu L Huang X You C Li J Hong K et al (2017) Prevalence and Risk Factors of Prehypertension and Hypertension in Southern China PLOS ONE 12(1) e0170238 doi101371journalpone0170238httpjournalsplosorgplosonearticleid=101371journalpone0170238

PLOS 2017

Prehypertension and stroke risk

Noumerous abnormalities in borderline hypertension according to ProfJulius

bull High cardiac output fast heart rate

bull Abnormal vascular resistance

bull Low plasma volume high hematocrit

bull Several metabolic abnormalities

Age distribution (Slovenia 2009)

0

5

10

15

20

25

30

35

20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-99

Age

Age distribution

Normal BP

New diagnose

HNBP

Hypertension

Risk Factors - Tecumseh BP Study

Normotensive

(n=822) Borderline

(n=124)

p

Cholesterol (mgdL) 176 190 0001

HDL (mgdL) 43 40 001

Triglycerides

(mgdL) 95 135 0001

Insulin (UdL) 12 18 0001

Glucose (mgdL) 92 95 001

Insulin-glucose ratio 0155 0200 0001

Percent overweight 136 301 lt0001

Julius S et al JAMA 1990 264 354-358

Prevalence of prehypertension and hypertension stratified by Visceral Adipose Index and Body Fat Percentage

Hu L Huang X You C Li J Hong K et al (2017) Prevalence and Risk Factors of Prehypertension and Hypertension in Southern China PLOS ONE 12(1) e0170238 doi101371journalpone0170238httpjournalsplosorgplosonearticleid=101371journalpone0170238

PLOS 2017

Noumerous abnormalities in borderline hypertension according to ProfJulius

bull High cardiac output fast heart rate

bull Abnormal vascular resistance

bull Low plasma volume high hematocrit

bull Several metabolic abnormalities

Age distribution (Slovenia 2009)

0

5

10

15

20

25

30

35

20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-99

Age

Age distribution

Normal BP

New diagnose

HNBP

Hypertension

Risk Factors - Tecumseh BP Study

Normotensive

(n=822) Borderline

(n=124)

p

Cholesterol (mgdL) 176 190 0001

HDL (mgdL) 43 40 001

Triglycerides

(mgdL) 95 135 0001

Insulin (UdL) 12 18 0001

Glucose (mgdL) 92 95 001

Insulin-glucose ratio 0155 0200 0001

Percent overweight 136 301 lt0001

Julius S et al JAMA 1990 264 354-358

Prevalence of prehypertension and hypertension stratified by Visceral Adipose Index and Body Fat Percentage

Hu L Huang X You C Li J Hong K et al (2017) Prevalence and Risk Factors of Prehypertension and Hypertension in Southern China PLOS ONE 12(1) e0170238 doi101371journalpone0170238httpjournalsplosorgplosonearticleid=101371journalpone0170238

PLOS 2017

Age distribution (Slovenia 2009)

0

5

10

15

20

25

30

35

20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-99

Age

Age distribution

Normal BP

New diagnose

HNBP

Hypertension

Risk Factors - Tecumseh BP Study

Normotensive

(n=822) Borderline

(n=124)

p

Cholesterol (mgdL) 176 190 0001

HDL (mgdL) 43 40 001

Triglycerides

(mgdL) 95 135 0001

Insulin (UdL) 12 18 0001

Glucose (mgdL) 92 95 001

Insulin-glucose ratio 0155 0200 0001

Percent overweight 136 301 lt0001

Julius S et al JAMA 1990 264 354-358

Prevalence of prehypertension and hypertension stratified by Visceral Adipose Index and Body Fat Percentage

Hu L Huang X You C Li J Hong K et al (2017) Prevalence and Risk Factors of Prehypertension and Hypertension in Southern China PLOS ONE 12(1) e0170238 doi101371journalpone0170238httpjournalsplosorgplosonearticleid=101371journalpone0170238

PLOS 2017

Risk Factors - Tecumseh BP Study

Normotensive

(n=822) Borderline

(n=124)

p

Cholesterol (mgdL) 176 190 0001

HDL (mgdL) 43 40 001

Triglycerides

(mgdL) 95 135 0001

Insulin (UdL) 12 18 0001

Glucose (mgdL) 92 95 001

Insulin-glucose ratio 0155 0200 0001

Percent overweight 136 301 lt0001

Julius S et al JAMA 1990 264 354-358

Prevalence of prehypertension and hypertension stratified by Visceral Adipose Index and Body Fat Percentage

Hu L Huang X You C Li J Hong K et al (2017) Prevalence and Risk Factors of Prehypertension and Hypertension in Southern China PLOS ONE 12(1) e0170238 doi101371journalpone0170238httpjournalsplosorgplosonearticleid=101371journalpone0170238

PLOS 2017

Prevalence of prehypertension and hypertension stratified by Visceral Adipose Index and Body Fat Percentage

Hu L Huang X You C Li J Hong K et al (2017) Prevalence and Risk Factors of Prehypertension and Hypertension in Southern China PLOS ONE 12(1) e0170238 doi101371journalpone0170238httpjournalsplosorgplosonearticleid=101371journalpone0170238

PLOS 2017

Framingham Study incidence of hypertension

Vasan LarsonLevy Lancet 2001

Flemish Study Belgiumincidence of hypertension

(781 women 675 men)

Zhang H Fagard R Staessen J J Hypertension 2006

1 summary

bull Prehypertensives are more obese have higher cholesterol levels blood glucose insuline resistance heart rate

bull Stage by itself and progression to hypertension

Letrsquos go for a drink

Definition of prehypertension

stage Outpatient BP

(mmHg)

Home BP

(mmHg)

ABMP (mmHg)

24-h Day-time Night-time

Normotension lt12080

Prehypertension 120-13980-89

Hypertension ge14090 gt13585 gt13080 gt13585 gt12070

BP Thresholds for Definition of Hypertension

High office BP

Normal home BP

ldquoWhite-coatrdquo hypertension

Normal office BP

Normal home BP

ldquoNormotensionrdquo

High office BP

High home BP

Sustained hypertension

Normal office BP

High home BP

Masked hypertension

14090 mmHg

lt13585mmHgHome BP

Office BP

Masked hypertension

0

40

80

120

160

200

0

40

80

120

160

200

12 14 16 18 20 22 0 2 4 6 8 10 12 14

Blo

od

pre

ssure

(mm

Hg)

H

eart

rate

(min

-1)

Time (hour)

Blood pressureHeart rate

Man 20 yearsDaytime 152 87 mm Hg

Night-time 130 71 mm HgNight-time BP Drop -15 -18

Home blood pressure consistently hypertensiveClinic blood pressure 11070 mm Hg target organs damage

12 cohorts

Copenhagen (Denmark)

Dublin (Ireland)

Jingning (China)

Krakoacutew (Poland)

Maracaibo (Venezuela)

Montevideo (Uruguay)

Noorderkempen (Belgium)

Novosibirsk (Russia)

Ohasama (Japan)

Padova (Italy)

Pilsen (Czechia)

Uppsala (Sweden)

To study risk stratification by ABPM in people stratified by CBP

categories The International Database on Ambulatory blood

pressure in relation to Cardiovascular Outcomes (IDACO)

IDACO

Database

Standardised questionnaires

Anthropometric measurements

CBP and ABP

Blood sample (cholesterol glucose etc)

Outcome of participants

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

CV prediction

IDACOdatabase

Cardiovascualr risk based on BP measured in outpatient

8

7

6

5

4

3

2

1

0

0 3 6 9 12 15

20

15

10

05

0

0 3 6 9 12 15

Follow-up (years) Follow-up (years)

CV

eve

nts

(

)

Adjusted for cohort sex age BMI smoking and drinking serum cholesterol CV disease and DM

Cardiovascular events Stroke

Stro

ke(

)

HT

Pre-HT

NT

Plt00001

p=0012

HT

Pre-HT

NT

p=0015

Plt00001

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

IDACO HRs (vs NT) associated with masked HT

05 1 2 4 8 05 1 2 4 8

NT 2441 63 2441 13

NT with masked HT 198 14 198 5

Pre-HT with masked HT 900 90 900 31

No ofsubjects

No ofevents

No ofsubjects

No ofevents

CV events Stroke

Daytime BP thresholds ge13585 mmHg

212 (p=00058)

222 (plt00001)

275 (p=0026)

301 (plt00001)

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

IDACO HRs (vs NT) associated with masked HT

NT 2527 67 2527 14

NT with masked HT 112 10 112 4

Pre-HT with masked HT 672 74 672 27

No ofsubjects

No ofevents

No ofsubjects

No ofevents

CV events Stroke

05 1 2 4 8 05 1 2 4 8

24h BP thresholds ge13080 mmHg

258 (p=00032)

213 (plt00001)

418 (p=00047)

317 (plt00001)

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

Home blood pressure and ABPM in detecting masked hypertension (same sample N=128 )

CV riskUpgraded 117Downgraded 148No change 734

Masked hypertensionHome BPM748ABPM 131

MH = masked hypertensionNR = normotensionSH = sustained hypertension

RISHO2014

Baseline to follow-up reproducibility of home blood pressure measurements in tertiles of the follow up duration

RISHO2014

100 120 140 160

-40

-20

0

20

40

CR=176

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=161

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=198

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=218

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=212

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=242

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

a) 1tertile

b) 2tertile

c) 3tertile

Bland and Altman method CR=coefficient of reproducibility twice of SD of the difference between repeated measurement

Observation 24y

43y

59y

Home Blood Pressure as a Predictor of Future Blood Pressure Stability in Borderline HypertensionThe Tecumseh StudyS D Nesbitt J V Amerena EGrant K A Jamerson H Lu A Weder Stevo Julius

JAMA 2016315(23)2564-2575

Characteristics of Colorectal Cancer Screening Strategiesa

Screening for Colorectal Cancer vs ABPM in PrehypertensionUS Preventive Services Task Force Recommendation Statement

PrehypertensionOutpatient BP

Home BPEvery year

ABPMif expected risk MH or

large CV risk

Conformation of MH

Medical treatment on time

Confirmation with ABPM

Treat or not to treat prehypertension this is the question now

bull lifestyle modification for those with prehypertension-the good news is that it works

Ideal cardiovascular health behaviors and factors prevent the development of hypertension inprehypertensive subjects

Gao J Sun H Liang X Gao M Zhao H Qi Y Wang Y Liu Y Li J Zhu Y Zhao Y Wang W Ma L Wu SClinical amp Experimental Hypertension (New York) 37(8)650-5 2015

bull BACKGROUND Seven ideal health metrics were defined by AHA to monitor cardiovascular health This study aimed to investigate the impact of ideal cardiovascular health behaviors and factors on the development of hypertension in prehypertensive subjects

METHODS Thirty-two thousand eight-hundred and eighty-seven participants with prehypertension were included in the study after excluding for preexisting stroke myocardial infarction or malignancy Cox proportional hazards regression was used to calculate hazard ratios and 95 confidence intervals [CI] for the development of hypertension

RESULTS During a follow-up of 522 months 15500 prehypertensive participants developed hypertension The cumulative incidence of hypertension decreased with the number of ideal health metrics increased It was 7861 7108 6315 5607 and 6162 in prehypertensive individuals carrying lt 1 2 3 4 and gt 5 ideal health behaviors or factors respectively After adjustment for age gender family history of hypertension alcohol consumption resting heart rate plasma triglyceride high-density lipoprotein cholesterol low-density lipoprotein cholesterol and high-sensitivity C-reactive protein the risk ratios of incident hypertension in the subjects who carried 2 3 4 and gt 5 ideal health metrics were 0833 (95CI 0789-0880) 0710 (95CI 0672-0749) 0604 (95CI 0568-0642) and 0581 (95CI 0524-0643) respectively in comparison to those with lt 1 ideal health metric A similar trend was also observed in male and female populations Poor health metrics including body mass index diet (salt intake) physical activity total cholesterol and smoking were predictors for the development of hypertension in prehypertensive individuals

CONCLUSION Ideal cardiovascular health behaviors and factors are protective factors to prevent the progression from prehypertension to hypertension

Flemish Study Belgiumincidence of hypertension

(781 women 675 men)

Zhang H Fagard R Staessen J J Hypertension 2006

1 summary

bull Prehypertensives are more obese have higher cholesterol levels blood glucose insuline resistance heart rate

bull Stage by itself and progression to hypertension

Letrsquos go for a drink

Definition of prehypertension

stage Outpatient BP

(mmHg)

Home BP

(mmHg)

ABMP (mmHg)

24-h Day-time Night-time

Normotension lt12080

Prehypertension 120-13980-89

Hypertension ge14090 gt13585 gt13080 gt13585 gt12070

BP Thresholds for Definition of Hypertension

High office BP

Normal home BP

ldquoWhite-coatrdquo hypertension

Normal office BP

Normal home BP

ldquoNormotensionrdquo

High office BP

High home BP

Sustained hypertension

Normal office BP

High home BP

Masked hypertension

14090 mmHg

lt13585mmHgHome BP

Office BP

Masked hypertension

0

40

80

120

160

200

0

40

80

120

160

200

12 14 16 18 20 22 0 2 4 6 8 10 12 14

Blo

od

pre

ssure

(mm

Hg)

H

eart

rate

(min

-1)

Time (hour)

Blood pressureHeart rate

Man 20 yearsDaytime 152 87 mm Hg

Night-time 130 71 mm HgNight-time BP Drop -15 -18

Home blood pressure consistently hypertensiveClinic blood pressure 11070 mm Hg target organs damage

12 cohorts

Copenhagen (Denmark)

Dublin (Ireland)

Jingning (China)

Krakoacutew (Poland)

Maracaibo (Venezuela)

Montevideo (Uruguay)

Noorderkempen (Belgium)

Novosibirsk (Russia)

Ohasama (Japan)

Padova (Italy)

Pilsen (Czechia)

Uppsala (Sweden)

To study risk stratification by ABPM in people stratified by CBP

categories The International Database on Ambulatory blood

pressure in relation to Cardiovascular Outcomes (IDACO)

IDACO

Database

Standardised questionnaires

Anthropometric measurements

CBP and ABP

Blood sample (cholesterol glucose etc)

Outcome of participants

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

CV prediction

IDACOdatabase

Cardiovascualr risk based on BP measured in outpatient

8

7

6

5

4

3

2

1

0

0 3 6 9 12 15

20

15

10

05

0

0 3 6 9 12 15

Follow-up (years) Follow-up (years)

CV

eve

nts

(

)

Adjusted for cohort sex age BMI smoking and drinking serum cholesterol CV disease and DM

Cardiovascular events Stroke

Stro

ke(

)

HT

Pre-HT

NT

Plt00001

p=0012

HT

Pre-HT

NT

p=0015

Plt00001

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

IDACO HRs (vs NT) associated with masked HT

05 1 2 4 8 05 1 2 4 8

NT 2441 63 2441 13

NT with masked HT 198 14 198 5

Pre-HT with masked HT 900 90 900 31

No ofsubjects

No ofevents

No ofsubjects

No ofevents

CV events Stroke

Daytime BP thresholds ge13585 mmHg

212 (p=00058)

222 (plt00001)

275 (p=0026)

301 (plt00001)

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

IDACO HRs (vs NT) associated with masked HT

NT 2527 67 2527 14

NT with masked HT 112 10 112 4

Pre-HT with masked HT 672 74 672 27

No ofsubjects

No ofevents

No ofsubjects

No ofevents

CV events Stroke

05 1 2 4 8 05 1 2 4 8

24h BP thresholds ge13080 mmHg

258 (p=00032)

213 (plt00001)

418 (p=00047)

317 (plt00001)

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

Home blood pressure and ABPM in detecting masked hypertension (same sample N=128 )

CV riskUpgraded 117Downgraded 148No change 734

Masked hypertensionHome BPM748ABPM 131

MH = masked hypertensionNR = normotensionSH = sustained hypertension

RISHO2014

Baseline to follow-up reproducibility of home blood pressure measurements in tertiles of the follow up duration

RISHO2014

100 120 140 160

-40

-20

0

20

40

CR=176

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=161

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=198

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=218

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=212

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=242

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

a) 1tertile

b) 2tertile

c) 3tertile

Bland and Altman method CR=coefficient of reproducibility twice of SD of the difference between repeated measurement

Observation 24y

43y

59y

Home Blood Pressure as a Predictor of Future Blood Pressure Stability in Borderline HypertensionThe Tecumseh StudyS D Nesbitt J V Amerena EGrant K A Jamerson H Lu A Weder Stevo Julius

JAMA 2016315(23)2564-2575

Characteristics of Colorectal Cancer Screening Strategiesa

Screening for Colorectal Cancer vs ABPM in PrehypertensionUS Preventive Services Task Force Recommendation Statement

PrehypertensionOutpatient BP

Home BPEvery year

ABPMif expected risk MH or

large CV risk

Conformation of MH

Medical treatment on time

Confirmation with ABPM

Treat or not to treat prehypertension this is the question now

bull lifestyle modification for those with prehypertension-the good news is that it works

Ideal cardiovascular health behaviors and factors prevent the development of hypertension inprehypertensive subjects

Gao J Sun H Liang X Gao M Zhao H Qi Y Wang Y Liu Y Li J Zhu Y Zhao Y Wang W Ma L Wu SClinical amp Experimental Hypertension (New York) 37(8)650-5 2015

bull BACKGROUND Seven ideal health metrics were defined by AHA to monitor cardiovascular health This study aimed to investigate the impact of ideal cardiovascular health behaviors and factors on the development of hypertension in prehypertensive subjects

METHODS Thirty-two thousand eight-hundred and eighty-seven participants with prehypertension were included in the study after excluding for preexisting stroke myocardial infarction or malignancy Cox proportional hazards regression was used to calculate hazard ratios and 95 confidence intervals [CI] for the development of hypertension

RESULTS During a follow-up of 522 months 15500 prehypertensive participants developed hypertension The cumulative incidence of hypertension decreased with the number of ideal health metrics increased It was 7861 7108 6315 5607 and 6162 in prehypertensive individuals carrying lt 1 2 3 4 and gt 5 ideal health behaviors or factors respectively After adjustment for age gender family history of hypertension alcohol consumption resting heart rate plasma triglyceride high-density lipoprotein cholesterol low-density lipoprotein cholesterol and high-sensitivity C-reactive protein the risk ratios of incident hypertension in the subjects who carried 2 3 4 and gt 5 ideal health metrics were 0833 (95CI 0789-0880) 0710 (95CI 0672-0749) 0604 (95CI 0568-0642) and 0581 (95CI 0524-0643) respectively in comparison to those with lt 1 ideal health metric A similar trend was also observed in male and female populations Poor health metrics including body mass index diet (salt intake) physical activity total cholesterol and smoking were predictors for the development of hypertension in prehypertensive individuals

CONCLUSION Ideal cardiovascular health behaviors and factors are protective factors to prevent the progression from prehypertension to hypertension

1 summary

bull Prehypertensives are more obese have higher cholesterol levels blood glucose insuline resistance heart rate

bull Stage by itself and progression to hypertension

Letrsquos go for a drink

Definition of prehypertension

stage Outpatient BP

(mmHg)

Home BP

(mmHg)

ABMP (mmHg)

24-h Day-time Night-time

Normotension lt12080

Prehypertension 120-13980-89

Hypertension ge14090 gt13585 gt13080 gt13585 gt12070

BP Thresholds for Definition of Hypertension

High office BP

Normal home BP

ldquoWhite-coatrdquo hypertension

Normal office BP

Normal home BP

ldquoNormotensionrdquo

High office BP

High home BP

Sustained hypertension

Normal office BP

High home BP

Masked hypertension

14090 mmHg

lt13585mmHgHome BP

Office BP

Masked hypertension

0

40

80

120

160

200

0

40

80

120

160

200

12 14 16 18 20 22 0 2 4 6 8 10 12 14

Blo

od

pre

ssure

(mm

Hg)

H

eart

rate

(min

-1)

Time (hour)

Blood pressureHeart rate

Man 20 yearsDaytime 152 87 mm Hg

Night-time 130 71 mm HgNight-time BP Drop -15 -18

Home blood pressure consistently hypertensiveClinic blood pressure 11070 mm Hg target organs damage

12 cohorts

Copenhagen (Denmark)

Dublin (Ireland)

Jingning (China)

Krakoacutew (Poland)

Maracaibo (Venezuela)

Montevideo (Uruguay)

Noorderkempen (Belgium)

Novosibirsk (Russia)

Ohasama (Japan)

Padova (Italy)

Pilsen (Czechia)

Uppsala (Sweden)

To study risk stratification by ABPM in people stratified by CBP

categories The International Database on Ambulatory blood

pressure in relation to Cardiovascular Outcomes (IDACO)

IDACO

Database

Standardised questionnaires

Anthropometric measurements

CBP and ABP

Blood sample (cholesterol glucose etc)

Outcome of participants

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

CV prediction

IDACOdatabase

Cardiovascualr risk based on BP measured in outpatient

8

7

6

5

4

3

2

1

0

0 3 6 9 12 15

20

15

10

05

0

0 3 6 9 12 15

Follow-up (years) Follow-up (years)

CV

eve

nts

(

)

Adjusted for cohort sex age BMI smoking and drinking serum cholesterol CV disease and DM

Cardiovascular events Stroke

Stro

ke(

)

HT

Pre-HT

NT

Plt00001

p=0012

HT

Pre-HT

NT

p=0015

Plt00001

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

IDACO HRs (vs NT) associated with masked HT

05 1 2 4 8 05 1 2 4 8

NT 2441 63 2441 13

NT with masked HT 198 14 198 5

Pre-HT with masked HT 900 90 900 31

No ofsubjects

No ofevents

No ofsubjects

No ofevents

CV events Stroke

Daytime BP thresholds ge13585 mmHg

212 (p=00058)

222 (plt00001)

275 (p=0026)

301 (plt00001)

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

IDACO HRs (vs NT) associated with masked HT

NT 2527 67 2527 14

NT with masked HT 112 10 112 4

Pre-HT with masked HT 672 74 672 27

No ofsubjects

No ofevents

No ofsubjects

No ofevents

CV events Stroke

05 1 2 4 8 05 1 2 4 8

24h BP thresholds ge13080 mmHg

258 (p=00032)

213 (plt00001)

418 (p=00047)

317 (plt00001)

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

Home blood pressure and ABPM in detecting masked hypertension (same sample N=128 )

CV riskUpgraded 117Downgraded 148No change 734

Masked hypertensionHome BPM748ABPM 131

MH = masked hypertensionNR = normotensionSH = sustained hypertension

RISHO2014

Baseline to follow-up reproducibility of home blood pressure measurements in tertiles of the follow up duration

RISHO2014

100 120 140 160

-40

-20

0

20

40

CR=176

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=161

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=198

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=218

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=212

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=242

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

a) 1tertile

b) 2tertile

c) 3tertile

Bland and Altman method CR=coefficient of reproducibility twice of SD of the difference between repeated measurement

Observation 24y

43y

59y

Home Blood Pressure as a Predictor of Future Blood Pressure Stability in Borderline HypertensionThe Tecumseh StudyS D Nesbitt J V Amerena EGrant K A Jamerson H Lu A Weder Stevo Julius

JAMA 2016315(23)2564-2575

Characteristics of Colorectal Cancer Screening Strategiesa

Screening for Colorectal Cancer vs ABPM in PrehypertensionUS Preventive Services Task Force Recommendation Statement

PrehypertensionOutpatient BP

Home BPEvery year

ABPMif expected risk MH or

large CV risk

Conformation of MH

Medical treatment on time

Confirmation with ABPM

Treat or not to treat prehypertension this is the question now

bull lifestyle modification for those with prehypertension-the good news is that it works

Ideal cardiovascular health behaviors and factors prevent the development of hypertension inprehypertensive subjects

Gao J Sun H Liang X Gao M Zhao H Qi Y Wang Y Liu Y Li J Zhu Y Zhao Y Wang W Ma L Wu SClinical amp Experimental Hypertension (New York) 37(8)650-5 2015

bull BACKGROUND Seven ideal health metrics were defined by AHA to monitor cardiovascular health This study aimed to investigate the impact of ideal cardiovascular health behaviors and factors on the development of hypertension in prehypertensive subjects

METHODS Thirty-two thousand eight-hundred and eighty-seven participants with prehypertension were included in the study after excluding for preexisting stroke myocardial infarction or malignancy Cox proportional hazards regression was used to calculate hazard ratios and 95 confidence intervals [CI] for the development of hypertension

RESULTS During a follow-up of 522 months 15500 prehypertensive participants developed hypertension The cumulative incidence of hypertension decreased with the number of ideal health metrics increased It was 7861 7108 6315 5607 and 6162 in prehypertensive individuals carrying lt 1 2 3 4 and gt 5 ideal health behaviors or factors respectively After adjustment for age gender family history of hypertension alcohol consumption resting heart rate plasma triglyceride high-density lipoprotein cholesterol low-density lipoprotein cholesterol and high-sensitivity C-reactive protein the risk ratios of incident hypertension in the subjects who carried 2 3 4 and gt 5 ideal health metrics were 0833 (95CI 0789-0880) 0710 (95CI 0672-0749) 0604 (95CI 0568-0642) and 0581 (95CI 0524-0643) respectively in comparison to those with lt 1 ideal health metric A similar trend was also observed in male and female populations Poor health metrics including body mass index diet (salt intake) physical activity total cholesterol and smoking were predictors for the development of hypertension in prehypertensive individuals

CONCLUSION Ideal cardiovascular health behaviors and factors are protective factors to prevent the progression from prehypertension to hypertension

Letrsquos go for a drink

Definition of prehypertension

stage Outpatient BP

(mmHg)

Home BP

(mmHg)

ABMP (mmHg)

24-h Day-time Night-time

Normotension lt12080

Prehypertension 120-13980-89

Hypertension ge14090 gt13585 gt13080 gt13585 gt12070

BP Thresholds for Definition of Hypertension

High office BP

Normal home BP

ldquoWhite-coatrdquo hypertension

Normal office BP

Normal home BP

ldquoNormotensionrdquo

High office BP

High home BP

Sustained hypertension

Normal office BP

High home BP

Masked hypertension

14090 mmHg

lt13585mmHgHome BP

Office BP

Masked hypertension

0

40

80

120

160

200

0

40

80

120

160

200

12 14 16 18 20 22 0 2 4 6 8 10 12 14

Blo

od

pre

ssure

(mm

Hg)

H

eart

rate

(min

-1)

Time (hour)

Blood pressureHeart rate

Man 20 yearsDaytime 152 87 mm Hg

Night-time 130 71 mm HgNight-time BP Drop -15 -18

Home blood pressure consistently hypertensiveClinic blood pressure 11070 mm Hg target organs damage

12 cohorts

Copenhagen (Denmark)

Dublin (Ireland)

Jingning (China)

Krakoacutew (Poland)

Maracaibo (Venezuela)

Montevideo (Uruguay)

Noorderkempen (Belgium)

Novosibirsk (Russia)

Ohasama (Japan)

Padova (Italy)

Pilsen (Czechia)

Uppsala (Sweden)

To study risk stratification by ABPM in people stratified by CBP

categories The International Database on Ambulatory blood

pressure in relation to Cardiovascular Outcomes (IDACO)

IDACO

Database

Standardised questionnaires

Anthropometric measurements

CBP and ABP

Blood sample (cholesterol glucose etc)

Outcome of participants

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

CV prediction

IDACOdatabase

Cardiovascualr risk based on BP measured in outpatient

8

7

6

5

4

3

2

1

0

0 3 6 9 12 15

20

15

10

05

0

0 3 6 9 12 15

Follow-up (years) Follow-up (years)

CV

eve

nts

(

)

Adjusted for cohort sex age BMI smoking and drinking serum cholesterol CV disease and DM

Cardiovascular events Stroke

Stro

ke(

)

HT

Pre-HT

NT

Plt00001

p=0012

HT

Pre-HT

NT

p=0015

Plt00001

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

IDACO HRs (vs NT) associated with masked HT

05 1 2 4 8 05 1 2 4 8

NT 2441 63 2441 13

NT with masked HT 198 14 198 5

Pre-HT with masked HT 900 90 900 31

No ofsubjects

No ofevents

No ofsubjects

No ofevents

CV events Stroke

Daytime BP thresholds ge13585 mmHg

212 (p=00058)

222 (plt00001)

275 (p=0026)

301 (plt00001)

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

IDACO HRs (vs NT) associated with masked HT

NT 2527 67 2527 14

NT with masked HT 112 10 112 4

Pre-HT with masked HT 672 74 672 27

No ofsubjects

No ofevents

No ofsubjects

No ofevents

CV events Stroke

05 1 2 4 8 05 1 2 4 8

24h BP thresholds ge13080 mmHg

258 (p=00032)

213 (plt00001)

418 (p=00047)

317 (plt00001)

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

Home blood pressure and ABPM in detecting masked hypertension (same sample N=128 )

CV riskUpgraded 117Downgraded 148No change 734

Masked hypertensionHome BPM748ABPM 131

MH = masked hypertensionNR = normotensionSH = sustained hypertension

RISHO2014

Baseline to follow-up reproducibility of home blood pressure measurements in tertiles of the follow up duration

RISHO2014

100 120 140 160

-40

-20

0

20

40

CR=176

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=161

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=198

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=218

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=212

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=242

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

a) 1tertile

b) 2tertile

c) 3tertile

Bland and Altman method CR=coefficient of reproducibility twice of SD of the difference between repeated measurement

Observation 24y

43y

59y

Home Blood Pressure as a Predictor of Future Blood Pressure Stability in Borderline HypertensionThe Tecumseh StudyS D Nesbitt J V Amerena EGrant K A Jamerson H Lu A Weder Stevo Julius

JAMA 2016315(23)2564-2575

Characteristics of Colorectal Cancer Screening Strategiesa

Screening for Colorectal Cancer vs ABPM in PrehypertensionUS Preventive Services Task Force Recommendation Statement

PrehypertensionOutpatient BP

Home BPEvery year

ABPMif expected risk MH or

large CV risk

Conformation of MH

Medical treatment on time

Confirmation with ABPM

Treat or not to treat prehypertension this is the question now

bull lifestyle modification for those with prehypertension-the good news is that it works

Ideal cardiovascular health behaviors and factors prevent the development of hypertension inprehypertensive subjects

Gao J Sun H Liang X Gao M Zhao H Qi Y Wang Y Liu Y Li J Zhu Y Zhao Y Wang W Ma L Wu SClinical amp Experimental Hypertension (New York) 37(8)650-5 2015

bull BACKGROUND Seven ideal health metrics were defined by AHA to monitor cardiovascular health This study aimed to investigate the impact of ideal cardiovascular health behaviors and factors on the development of hypertension in prehypertensive subjects

METHODS Thirty-two thousand eight-hundred and eighty-seven participants with prehypertension were included in the study after excluding for preexisting stroke myocardial infarction or malignancy Cox proportional hazards regression was used to calculate hazard ratios and 95 confidence intervals [CI] for the development of hypertension

RESULTS During a follow-up of 522 months 15500 prehypertensive participants developed hypertension The cumulative incidence of hypertension decreased with the number of ideal health metrics increased It was 7861 7108 6315 5607 and 6162 in prehypertensive individuals carrying lt 1 2 3 4 and gt 5 ideal health behaviors or factors respectively After adjustment for age gender family history of hypertension alcohol consumption resting heart rate plasma triglyceride high-density lipoprotein cholesterol low-density lipoprotein cholesterol and high-sensitivity C-reactive protein the risk ratios of incident hypertension in the subjects who carried 2 3 4 and gt 5 ideal health metrics were 0833 (95CI 0789-0880) 0710 (95CI 0672-0749) 0604 (95CI 0568-0642) and 0581 (95CI 0524-0643) respectively in comparison to those with lt 1 ideal health metric A similar trend was also observed in male and female populations Poor health metrics including body mass index diet (salt intake) physical activity total cholesterol and smoking were predictors for the development of hypertension in prehypertensive individuals

CONCLUSION Ideal cardiovascular health behaviors and factors are protective factors to prevent the progression from prehypertension to hypertension

Definition of prehypertension

stage Outpatient BP

(mmHg)

Home BP

(mmHg)

ABMP (mmHg)

24-h Day-time Night-time

Normotension lt12080

Prehypertension 120-13980-89

Hypertension ge14090 gt13585 gt13080 gt13585 gt12070

BP Thresholds for Definition of Hypertension

High office BP

Normal home BP

ldquoWhite-coatrdquo hypertension

Normal office BP

Normal home BP

ldquoNormotensionrdquo

High office BP

High home BP

Sustained hypertension

Normal office BP

High home BP

Masked hypertension

14090 mmHg

lt13585mmHgHome BP

Office BP

Masked hypertension

0

40

80

120

160

200

0

40

80

120

160

200

12 14 16 18 20 22 0 2 4 6 8 10 12 14

Blo

od

pre

ssure

(mm

Hg)

H

eart

rate

(min

-1)

Time (hour)

Blood pressureHeart rate

Man 20 yearsDaytime 152 87 mm Hg

Night-time 130 71 mm HgNight-time BP Drop -15 -18

Home blood pressure consistently hypertensiveClinic blood pressure 11070 mm Hg target organs damage

12 cohorts

Copenhagen (Denmark)

Dublin (Ireland)

Jingning (China)

Krakoacutew (Poland)

Maracaibo (Venezuela)

Montevideo (Uruguay)

Noorderkempen (Belgium)

Novosibirsk (Russia)

Ohasama (Japan)

Padova (Italy)

Pilsen (Czechia)

Uppsala (Sweden)

To study risk stratification by ABPM in people stratified by CBP

categories The International Database on Ambulatory blood

pressure in relation to Cardiovascular Outcomes (IDACO)

IDACO

Database

Standardised questionnaires

Anthropometric measurements

CBP and ABP

Blood sample (cholesterol glucose etc)

Outcome of participants

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

CV prediction

IDACOdatabase

Cardiovascualr risk based on BP measured in outpatient

8

7

6

5

4

3

2

1

0

0 3 6 9 12 15

20

15

10

05

0

0 3 6 9 12 15

Follow-up (years) Follow-up (years)

CV

eve

nts

(

)

Adjusted for cohort sex age BMI smoking and drinking serum cholesterol CV disease and DM

Cardiovascular events Stroke

Stro

ke(

)

HT

Pre-HT

NT

Plt00001

p=0012

HT

Pre-HT

NT

p=0015

Plt00001

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

IDACO HRs (vs NT) associated with masked HT

05 1 2 4 8 05 1 2 4 8

NT 2441 63 2441 13

NT with masked HT 198 14 198 5

Pre-HT with masked HT 900 90 900 31

No ofsubjects

No ofevents

No ofsubjects

No ofevents

CV events Stroke

Daytime BP thresholds ge13585 mmHg

212 (p=00058)

222 (plt00001)

275 (p=0026)

301 (plt00001)

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

IDACO HRs (vs NT) associated with masked HT

NT 2527 67 2527 14

NT with masked HT 112 10 112 4

Pre-HT with masked HT 672 74 672 27

No ofsubjects

No ofevents

No ofsubjects

No ofevents

CV events Stroke

05 1 2 4 8 05 1 2 4 8

24h BP thresholds ge13080 mmHg

258 (p=00032)

213 (plt00001)

418 (p=00047)

317 (plt00001)

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

Home blood pressure and ABPM in detecting masked hypertension (same sample N=128 )

CV riskUpgraded 117Downgraded 148No change 734

Masked hypertensionHome BPM748ABPM 131

MH = masked hypertensionNR = normotensionSH = sustained hypertension

RISHO2014

Baseline to follow-up reproducibility of home blood pressure measurements in tertiles of the follow up duration

RISHO2014

100 120 140 160

-40

-20

0

20

40

CR=176

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=161

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=198

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=218

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=212

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=242

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

a) 1tertile

b) 2tertile

c) 3tertile

Bland and Altman method CR=coefficient of reproducibility twice of SD of the difference between repeated measurement

Observation 24y

43y

59y

Home Blood Pressure as a Predictor of Future Blood Pressure Stability in Borderline HypertensionThe Tecumseh StudyS D Nesbitt J V Amerena EGrant K A Jamerson H Lu A Weder Stevo Julius

JAMA 2016315(23)2564-2575

Characteristics of Colorectal Cancer Screening Strategiesa

Screening for Colorectal Cancer vs ABPM in PrehypertensionUS Preventive Services Task Force Recommendation Statement

PrehypertensionOutpatient BP

Home BPEvery year

ABPMif expected risk MH or

large CV risk

Conformation of MH

Medical treatment on time

Confirmation with ABPM

Treat or not to treat prehypertension this is the question now

bull lifestyle modification for those with prehypertension-the good news is that it works

Ideal cardiovascular health behaviors and factors prevent the development of hypertension inprehypertensive subjects

Gao J Sun H Liang X Gao M Zhao H Qi Y Wang Y Liu Y Li J Zhu Y Zhao Y Wang W Ma L Wu SClinical amp Experimental Hypertension (New York) 37(8)650-5 2015

bull BACKGROUND Seven ideal health metrics were defined by AHA to monitor cardiovascular health This study aimed to investigate the impact of ideal cardiovascular health behaviors and factors on the development of hypertension in prehypertensive subjects

METHODS Thirty-two thousand eight-hundred and eighty-seven participants with prehypertension were included in the study after excluding for preexisting stroke myocardial infarction or malignancy Cox proportional hazards regression was used to calculate hazard ratios and 95 confidence intervals [CI] for the development of hypertension

RESULTS During a follow-up of 522 months 15500 prehypertensive participants developed hypertension The cumulative incidence of hypertension decreased with the number of ideal health metrics increased It was 7861 7108 6315 5607 and 6162 in prehypertensive individuals carrying lt 1 2 3 4 and gt 5 ideal health behaviors or factors respectively After adjustment for age gender family history of hypertension alcohol consumption resting heart rate plasma triglyceride high-density lipoprotein cholesterol low-density lipoprotein cholesterol and high-sensitivity C-reactive protein the risk ratios of incident hypertension in the subjects who carried 2 3 4 and gt 5 ideal health metrics were 0833 (95CI 0789-0880) 0710 (95CI 0672-0749) 0604 (95CI 0568-0642) and 0581 (95CI 0524-0643) respectively in comparison to those with lt 1 ideal health metric A similar trend was also observed in male and female populations Poor health metrics including body mass index diet (salt intake) physical activity total cholesterol and smoking were predictors for the development of hypertension in prehypertensive individuals

CONCLUSION Ideal cardiovascular health behaviors and factors are protective factors to prevent the progression from prehypertension to hypertension

BP Thresholds for Definition of Hypertension

High office BP

Normal home BP

ldquoWhite-coatrdquo hypertension

Normal office BP

Normal home BP

ldquoNormotensionrdquo

High office BP

High home BP

Sustained hypertension

Normal office BP

High home BP

Masked hypertension

14090 mmHg

lt13585mmHgHome BP

Office BP

Masked hypertension

0

40

80

120

160

200

0

40

80

120

160

200

12 14 16 18 20 22 0 2 4 6 8 10 12 14

Blo

od

pre

ssure

(mm

Hg)

H

eart

rate

(min

-1)

Time (hour)

Blood pressureHeart rate

Man 20 yearsDaytime 152 87 mm Hg

Night-time 130 71 mm HgNight-time BP Drop -15 -18

Home blood pressure consistently hypertensiveClinic blood pressure 11070 mm Hg target organs damage

12 cohorts

Copenhagen (Denmark)

Dublin (Ireland)

Jingning (China)

Krakoacutew (Poland)

Maracaibo (Venezuela)

Montevideo (Uruguay)

Noorderkempen (Belgium)

Novosibirsk (Russia)

Ohasama (Japan)

Padova (Italy)

Pilsen (Czechia)

Uppsala (Sweden)

To study risk stratification by ABPM in people stratified by CBP

categories The International Database on Ambulatory blood

pressure in relation to Cardiovascular Outcomes (IDACO)

IDACO

Database

Standardised questionnaires

Anthropometric measurements

CBP and ABP

Blood sample (cholesterol glucose etc)

Outcome of participants

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

CV prediction

IDACOdatabase

Cardiovascualr risk based on BP measured in outpatient

8

7

6

5

4

3

2

1

0

0 3 6 9 12 15

20

15

10

05

0

0 3 6 9 12 15

Follow-up (years) Follow-up (years)

CV

eve

nts

(

)

Adjusted for cohort sex age BMI smoking and drinking serum cholesterol CV disease and DM

Cardiovascular events Stroke

Stro

ke(

)

HT

Pre-HT

NT

Plt00001

p=0012

HT

Pre-HT

NT

p=0015

Plt00001

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

IDACO HRs (vs NT) associated with masked HT

05 1 2 4 8 05 1 2 4 8

NT 2441 63 2441 13

NT with masked HT 198 14 198 5

Pre-HT with masked HT 900 90 900 31

No ofsubjects

No ofevents

No ofsubjects

No ofevents

CV events Stroke

Daytime BP thresholds ge13585 mmHg

212 (p=00058)

222 (plt00001)

275 (p=0026)

301 (plt00001)

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

IDACO HRs (vs NT) associated with masked HT

NT 2527 67 2527 14

NT with masked HT 112 10 112 4

Pre-HT with masked HT 672 74 672 27

No ofsubjects

No ofevents

No ofsubjects

No ofevents

CV events Stroke

05 1 2 4 8 05 1 2 4 8

24h BP thresholds ge13080 mmHg

258 (p=00032)

213 (plt00001)

418 (p=00047)

317 (plt00001)

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

Home blood pressure and ABPM in detecting masked hypertension (same sample N=128 )

CV riskUpgraded 117Downgraded 148No change 734

Masked hypertensionHome BPM748ABPM 131

MH = masked hypertensionNR = normotensionSH = sustained hypertension

RISHO2014

Baseline to follow-up reproducibility of home blood pressure measurements in tertiles of the follow up duration

RISHO2014

100 120 140 160

-40

-20

0

20

40

CR=176

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=161

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=198

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=218

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=212

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=242

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

a) 1tertile

b) 2tertile

c) 3tertile

Bland and Altman method CR=coefficient of reproducibility twice of SD of the difference between repeated measurement

Observation 24y

43y

59y

Home Blood Pressure as a Predictor of Future Blood Pressure Stability in Borderline HypertensionThe Tecumseh StudyS D Nesbitt J V Amerena EGrant K A Jamerson H Lu A Weder Stevo Julius

JAMA 2016315(23)2564-2575

Characteristics of Colorectal Cancer Screening Strategiesa

Screening for Colorectal Cancer vs ABPM in PrehypertensionUS Preventive Services Task Force Recommendation Statement

PrehypertensionOutpatient BP

Home BPEvery year

ABPMif expected risk MH or

large CV risk

Conformation of MH

Medical treatment on time

Confirmation with ABPM

Treat or not to treat prehypertension this is the question now

bull lifestyle modification for those with prehypertension-the good news is that it works

Ideal cardiovascular health behaviors and factors prevent the development of hypertension inprehypertensive subjects

Gao J Sun H Liang X Gao M Zhao H Qi Y Wang Y Liu Y Li J Zhu Y Zhao Y Wang W Ma L Wu SClinical amp Experimental Hypertension (New York) 37(8)650-5 2015

bull BACKGROUND Seven ideal health metrics were defined by AHA to monitor cardiovascular health This study aimed to investigate the impact of ideal cardiovascular health behaviors and factors on the development of hypertension in prehypertensive subjects

METHODS Thirty-two thousand eight-hundred and eighty-seven participants with prehypertension were included in the study after excluding for preexisting stroke myocardial infarction or malignancy Cox proportional hazards regression was used to calculate hazard ratios and 95 confidence intervals [CI] for the development of hypertension

RESULTS During a follow-up of 522 months 15500 prehypertensive participants developed hypertension The cumulative incidence of hypertension decreased with the number of ideal health metrics increased It was 7861 7108 6315 5607 and 6162 in prehypertensive individuals carrying lt 1 2 3 4 and gt 5 ideal health behaviors or factors respectively After adjustment for age gender family history of hypertension alcohol consumption resting heart rate plasma triglyceride high-density lipoprotein cholesterol low-density lipoprotein cholesterol and high-sensitivity C-reactive protein the risk ratios of incident hypertension in the subjects who carried 2 3 4 and gt 5 ideal health metrics were 0833 (95CI 0789-0880) 0710 (95CI 0672-0749) 0604 (95CI 0568-0642) and 0581 (95CI 0524-0643) respectively in comparison to those with lt 1 ideal health metric A similar trend was also observed in male and female populations Poor health metrics including body mass index diet (salt intake) physical activity total cholesterol and smoking were predictors for the development of hypertension in prehypertensive individuals

CONCLUSION Ideal cardiovascular health behaviors and factors are protective factors to prevent the progression from prehypertension to hypertension

Masked hypertension

0

40

80

120

160

200

0

40

80

120

160

200

12 14 16 18 20 22 0 2 4 6 8 10 12 14

Blo

od

pre

ssure

(mm

Hg)

H

eart

rate

(min

-1)

Time (hour)

Blood pressureHeart rate

Man 20 yearsDaytime 152 87 mm Hg

Night-time 130 71 mm HgNight-time BP Drop -15 -18

Home blood pressure consistently hypertensiveClinic blood pressure 11070 mm Hg target organs damage

12 cohorts

Copenhagen (Denmark)

Dublin (Ireland)

Jingning (China)

Krakoacutew (Poland)

Maracaibo (Venezuela)

Montevideo (Uruguay)

Noorderkempen (Belgium)

Novosibirsk (Russia)

Ohasama (Japan)

Padova (Italy)

Pilsen (Czechia)

Uppsala (Sweden)

To study risk stratification by ABPM in people stratified by CBP

categories The International Database on Ambulatory blood

pressure in relation to Cardiovascular Outcomes (IDACO)

IDACO

Database

Standardised questionnaires

Anthropometric measurements

CBP and ABP

Blood sample (cholesterol glucose etc)

Outcome of participants

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

CV prediction

IDACOdatabase

Cardiovascualr risk based on BP measured in outpatient

8

7

6

5

4

3

2

1

0

0 3 6 9 12 15

20

15

10

05

0

0 3 6 9 12 15

Follow-up (years) Follow-up (years)

CV

eve

nts

(

)

Adjusted for cohort sex age BMI smoking and drinking serum cholesterol CV disease and DM

Cardiovascular events Stroke

Stro

ke(

)

HT

Pre-HT

NT

Plt00001

p=0012

HT

Pre-HT

NT

p=0015

Plt00001

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

IDACO HRs (vs NT) associated with masked HT

05 1 2 4 8 05 1 2 4 8

NT 2441 63 2441 13

NT with masked HT 198 14 198 5

Pre-HT with masked HT 900 90 900 31

No ofsubjects

No ofevents

No ofsubjects

No ofevents

CV events Stroke

Daytime BP thresholds ge13585 mmHg

212 (p=00058)

222 (plt00001)

275 (p=0026)

301 (plt00001)

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

IDACO HRs (vs NT) associated with masked HT

NT 2527 67 2527 14

NT with masked HT 112 10 112 4

Pre-HT with masked HT 672 74 672 27

No ofsubjects

No ofevents

No ofsubjects

No ofevents

CV events Stroke

05 1 2 4 8 05 1 2 4 8

24h BP thresholds ge13080 mmHg

258 (p=00032)

213 (plt00001)

418 (p=00047)

317 (plt00001)

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

Home blood pressure and ABPM in detecting masked hypertension (same sample N=128 )

CV riskUpgraded 117Downgraded 148No change 734

Masked hypertensionHome BPM748ABPM 131

MH = masked hypertensionNR = normotensionSH = sustained hypertension

RISHO2014

Baseline to follow-up reproducibility of home blood pressure measurements in tertiles of the follow up duration

RISHO2014

100 120 140 160

-40

-20

0

20

40

CR=176

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=161

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=198

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=218

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=212

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=242

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

a) 1tertile

b) 2tertile

c) 3tertile

Bland and Altman method CR=coefficient of reproducibility twice of SD of the difference between repeated measurement

Observation 24y

43y

59y

Home Blood Pressure as a Predictor of Future Blood Pressure Stability in Borderline HypertensionThe Tecumseh StudyS D Nesbitt J V Amerena EGrant K A Jamerson H Lu A Weder Stevo Julius

JAMA 2016315(23)2564-2575

Characteristics of Colorectal Cancer Screening Strategiesa

Screening for Colorectal Cancer vs ABPM in PrehypertensionUS Preventive Services Task Force Recommendation Statement

PrehypertensionOutpatient BP

Home BPEvery year

ABPMif expected risk MH or

large CV risk

Conformation of MH

Medical treatment on time

Confirmation with ABPM

Treat or not to treat prehypertension this is the question now

bull lifestyle modification for those with prehypertension-the good news is that it works

Ideal cardiovascular health behaviors and factors prevent the development of hypertension inprehypertensive subjects

Gao J Sun H Liang X Gao M Zhao H Qi Y Wang Y Liu Y Li J Zhu Y Zhao Y Wang W Ma L Wu SClinical amp Experimental Hypertension (New York) 37(8)650-5 2015

bull BACKGROUND Seven ideal health metrics were defined by AHA to monitor cardiovascular health This study aimed to investigate the impact of ideal cardiovascular health behaviors and factors on the development of hypertension in prehypertensive subjects

METHODS Thirty-two thousand eight-hundred and eighty-seven participants with prehypertension were included in the study after excluding for preexisting stroke myocardial infarction or malignancy Cox proportional hazards regression was used to calculate hazard ratios and 95 confidence intervals [CI] for the development of hypertension

RESULTS During a follow-up of 522 months 15500 prehypertensive participants developed hypertension The cumulative incidence of hypertension decreased with the number of ideal health metrics increased It was 7861 7108 6315 5607 and 6162 in prehypertensive individuals carrying lt 1 2 3 4 and gt 5 ideal health behaviors or factors respectively After adjustment for age gender family history of hypertension alcohol consumption resting heart rate plasma triglyceride high-density lipoprotein cholesterol low-density lipoprotein cholesterol and high-sensitivity C-reactive protein the risk ratios of incident hypertension in the subjects who carried 2 3 4 and gt 5 ideal health metrics were 0833 (95CI 0789-0880) 0710 (95CI 0672-0749) 0604 (95CI 0568-0642) and 0581 (95CI 0524-0643) respectively in comparison to those with lt 1 ideal health metric A similar trend was also observed in male and female populations Poor health metrics including body mass index diet (salt intake) physical activity total cholesterol and smoking were predictors for the development of hypertension in prehypertensive individuals

CONCLUSION Ideal cardiovascular health behaviors and factors are protective factors to prevent the progression from prehypertension to hypertension

12 cohorts

Copenhagen (Denmark)

Dublin (Ireland)

Jingning (China)

Krakoacutew (Poland)

Maracaibo (Venezuela)

Montevideo (Uruguay)

Noorderkempen (Belgium)

Novosibirsk (Russia)

Ohasama (Japan)

Padova (Italy)

Pilsen (Czechia)

Uppsala (Sweden)

To study risk stratification by ABPM in people stratified by CBP

categories The International Database on Ambulatory blood

pressure in relation to Cardiovascular Outcomes (IDACO)

IDACO

Database

Standardised questionnaires

Anthropometric measurements

CBP and ABP

Blood sample (cholesterol glucose etc)

Outcome of participants

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

CV prediction

IDACOdatabase

Cardiovascualr risk based on BP measured in outpatient

8

7

6

5

4

3

2

1

0

0 3 6 9 12 15

20

15

10

05

0

0 3 6 9 12 15

Follow-up (years) Follow-up (years)

CV

eve

nts

(

)

Adjusted for cohort sex age BMI smoking and drinking serum cholesterol CV disease and DM

Cardiovascular events Stroke

Stro

ke(

)

HT

Pre-HT

NT

Plt00001

p=0012

HT

Pre-HT

NT

p=0015

Plt00001

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

IDACO HRs (vs NT) associated with masked HT

05 1 2 4 8 05 1 2 4 8

NT 2441 63 2441 13

NT with masked HT 198 14 198 5

Pre-HT with masked HT 900 90 900 31

No ofsubjects

No ofevents

No ofsubjects

No ofevents

CV events Stroke

Daytime BP thresholds ge13585 mmHg

212 (p=00058)

222 (plt00001)

275 (p=0026)

301 (plt00001)

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

IDACO HRs (vs NT) associated with masked HT

NT 2527 67 2527 14

NT with masked HT 112 10 112 4

Pre-HT with masked HT 672 74 672 27

No ofsubjects

No ofevents

No ofsubjects

No ofevents

CV events Stroke

05 1 2 4 8 05 1 2 4 8

24h BP thresholds ge13080 mmHg

258 (p=00032)

213 (plt00001)

418 (p=00047)

317 (plt00001)

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

Home blood pressure and ABPM in detecting masked hypertension (same sample N=128 )

CV riskUpgraded 117Downgraded 148No change 734

Masked hypertensionHome BPM748ABPM 131

MH = masked hypertensionNR = normotensionSH = sustained hypertension

RISHO2014

Baseline to follow-up reproducibility of home blood pressure measurements in tertiles of the follow up duration

RISHO2014

100 120 140 160

-40

-20

0

20

40

CR=176

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=161

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=198

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=218

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=212

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=242

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

a) 1tertile

b) 2tertile

c) 3tertile

Bland and Altman method CR=coefficient of reproducibility twice of SD of the difference between repeated measurement

Observation 24y

43y

59y

Home Blood Pressure as a Predictor of Future Blood Pressure Stability in Borderline HypertensionThe Tecumseh StudyS D Nesbitt J V Amerena EGrant K A Jamerson H Lu A Weder Stevo Julius

JAMA 2016315(23)2564-2575

Characteristics of Colorectal Cancer Screening Strategiesa

Screening for Colorectal Cancer vs ABPM in PrehypertensionUS Preventive Services Task Force Recommendation Statement

PrehypertensionOutpatient BP

Home BPEvery year

ABPMif expected risk MH or

large CV risk

Conformation of MH

Medical treatment on time

Confirmation with ABPM

Treat or not to treat prehypertension this is the question now

bull lifestyle modification for those with prehypertension-the good news is that it works

Ideal cardiovascular health behaviors and factors prevent the development of hypertension inprehypertensive subjects

Gao J Sun H Liang X Gao M Zhao H Qi Y Wang Y Liu Y Li J Zhu Y Zhao Y Wang W Ma L Wu SClinical amp Experimental Hypertension (New York) 37(8)650-5 2015

bull BACKGROUND Seven ideal health metrics were defined by AHA to monitor cardiovascular health This study aimed to investigate the impact of ideal cardiovascular health behaviors and factors on the development of hypertension in prehypertensive subjects

METHODS Thirty-two thousand eight-hundred and eighty-seven participants with prehypertension were included in the study after excluding for preexisting stroke myocardial infarction or malignancy Cox proportional hazards regression was used to calculate hazard ratios and 95 confidence intervals [CI] for the development of hypertension

RESULTS During a follow-up of 522 months 15500 prehypertensive participants developed hypertension The cumulative incidence of hypertension decreased with the number of ideal health metrics increased It was 7861 7108 6315 5607 and 6162 in prehypertensive individuals carrying lt 1 2 3 4 and gt 5 ideal health behaviors or factors respectively After adjustment for age gender family history of hypertension alcohol consumption resting heart rate plasma triglyceride high-density lipoprotein cholesterol low-density lipoprotein cholesterol and high-sensitivity C-reactive protein the risk ratios of incident hypertension in the subjects who carried 2 3 4 and gt 5 ideal health metrics were 0833 (95CI 0789-0880) 0710 (95CI 0672-0749) 0604 (95CI 0568-0642) and 0581 (95CI 0524-0643) respectively in comparison to those with lt 1 ideal health metric A similar trend was also observed in male and female populations Poor health metrics including body mass index diet (salt intake) physical activity total cholesterol and smoking were predictors for the development of hypertension in prehypertensive individuals

CONCLUSION Ideal cardiovascular health behaviors and factors are protective factors to prevent the progression from prehypertension to hypertension

IDACOdatabase

Cardiovascualr risk based on BP measured in outpatient

8

7

6

5

4

3

2

1

0

0 3 6 9 12 15

20

15

10

05

0

0 3 6 9 12 15

Follow-up (years) Follow-up (years)

CV

eve

nts

(

)

Adjusted for cohort sex age BMI smoking and drinking serum cholesterol CV disease and DM

Cardiovascular events Stroke

Stro

ke(

)

HT

Pre-HT

NT

Plt00001

p=0012

HT

Pre-HT

NT

p=0015

Plt00001

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

IDACO HRs (vs NT) associated with masked HT

05 1 2 4 8 05 1 2 4 8

NT 2441 63 2441 13

NT with masked HT 198 14 198 5

Pre-HT with masked HT 900 90 900 31

No ofsubjects

No ofevents

No ofsubjects

No ofevents

CV events Stroke

Daytime BP thresholds ge13585 mmHg

212 (p=00058)

222 (plt00001)

275 (p=0026)

301 (plt00001)

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

IDACO HRs (vs NT) associated with masked HT

NT 2527 67 2527 14

NT with masked HT 112 10 112 4

Pre-HT with masked HT 672 74 672 27

No ofsubjects

No ofevents

No ofsubjects

No ofevents

CV events Stroke

05 1 2 4 8 05 1 2 4 8

24h BP thresholds ge13080 mmHg

258 (p=00032)

213 (plt00001)

418 (p=00047)

317 (plt00001)

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

Home blood pressure and ABPM in detecting masked hypertension (same sample N=128 )

CV riskUpgraded 117Downgraded 148No change 734

Masked hypertensionHome BPM748ABPM 131

MH = masked hypertensionNR = normotensionSH = sustained hypertension

RISHO2014

Baseline to follow-up reproducibility of home blood pressure measurements in tertiles of the follow up duration

RISHO2014

100 120 140 160

-40

-20

0

20

40

CR=176

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=161

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=198

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=218

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=212

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=242

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

a) 1tertile

b) 2tertile

c) 3tertile

Bland and Altman method CR=coefficient of reproducibility twice of SD of the difference between repeated measurement

Observation 24y

43y

59y

Home Blood Pressure as a Predictor of Future Blood Pressure Stability in Borderline HypertensionThe Tecumseh StudyS D Nesbitt J V Amerena EGrant K A Jamerson H Lu A Weder Stevo Julius

JAMA 2016315(23)2564-2575

Characteristics of Colorectal Cancer Screening Strategiesa

Screening for Colorectal Cancer vs ABPM in PrehypertensionUS Preventive Services Task Force Recommendation Statement

PrehypertensionOutpatient BP

Home BPEvery year

ABPMif expected risk MH or

large CV risk

Conformation of MH

Medical treatment on time

Confirmation with ABPM

Treat or not to treat prehypertension this is the question now

bull lifestyle modification for those with prehypertension-the good news is that it works

Ideal cardiovascular health behaviors and factors prevent the development of hypertension inprehypertensive subjects

Gao J Sun H Liang X Gao M Zhao H Qi Y Wang Y Liu Y Li J Zhu Y Zhao Y Wang W Ma L Wu SClinical amp Experimental Hypertension (New York) 37(8)650-5 2015

bull BACKGROUND Seven ideal health metrics were defined by AHA to monitor cardiovascular health This study aimed to investigate the impact of ideal cardiovascular health behaviors and factors on the development of hypertension in prehypertensive subjects

METHODS Thirty-two thousand eight-hundred and eighty-seven participants with prehypertension were included in the study after excluding for preexisting stroke myocardial infarction or malignancy Cox proportional hazards regression was used to calculate hazard ratios and 95 confidence intervals [CI] for the development of hypertension

RESULTS During a follow-up of 522 months 15500 prehypertensive participants developed hypertension The cumulative incidence of hypertension decreased with the number of ideal health metrics increased It was 7861 7108 6315 5607 and 6162 in prehypertensive individuals carrying lt 1 2 3 4 and gt 5 ideal health behaviors or factors respectively After adjustment for age gender family history of hypertension alcohol consumption resting heart rate plasma triglyceride high-density lipoprotein cholesterol low-density lipoprotein cholesterol and high-sensitivity C-reactive protein the risk ratios of incident hypertension in the subjects who carried 2 3 4 and gt 5 ideal health metrics were 0833 (95CI 0789-0880) 0710 (95CI 0672-0749) 0604 (95CI 0568-0642) and 0581 (95CI 0524-0643) respectively in comparison to those with lt 1 ideal health metric A similar trend was also observed in male and female populations Poor health metrics including body mass index diet (salt intake) physical activity total cholesterol and smoking were predictors for the development of hypertension in prehypertensive individuals

CONCLUSION Ideal cardiovascular health behaviors and factors are protective factors to prevent the progression from prehypertension to hypertension

IDACO HRs (vs NT) associated with masked HT

05 1 2 4 8 05 1 2 4 8

NT 2441 63 2441 13

NT with masked HT 198 14 198 5

Pre-HT with masked HT 900 90 900 31

No ofsubjects

No ofevents

No ofsubjects

No ofevents

CV events Stroke

Daytime BP thresholds ge13585 mmHg

212 (p=00058)

222 (plt00001)

275 (p=0026)

301 (plt00001)

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

IDACO HRs (vs NT) associated with masked HT

NT 2527 67 2527 14

NT with masked HT 112 10 112 4

Pre-HT with masked HT 672 74 672 27

No ofsubjects

No ofevents

No ofsubjects

No ofevents

CV events Stroke

05 1 2 4 8 05 1 2 4 8

24h BP thresholds ge13080 mmHg

258 (p=00032)

213 (plt00001)

418 (p=00047)

317 (plt00001)

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

Home blood pressure and ABPM in detecting masked hypertension (same sample N=128 )

CV riskUpgraded 117Downgraded 148No change 734

Masked hypertensionHome BPM748ABPM 131

MH = masked hypertensionNR = normotensionSH = sustained hypertension

RISHO2014

Baseline to follow-up reproducibility of home blood pressure measurements in tertiles of the follow up duration

RISHO2014

100 120 140 160

-40

-20

0

20

40

CR=176

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=161

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=198

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=218

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=212

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=242

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

a) 1tertile

b) 2tertile

c) 3tertile

Bland and Altman method CR=coefficient of reproducibility twice of SD of the difference between repeated measurement

Observation 24y

43y

59y

Home Blood Pressure as a Predictor of Future Blood Pressure Stability in Borderline HypertensionThe Tecumseh StudyS D Nesbitt J V Amerena EGrant K A Jamerson H Lu A Weder Stevo Julius

JAMA 2016315(23)2564-2575

Characteristics of Colorectal Cancer Screening Strategiesa

Screening for Colorectal Cancer vs ABPM in PrehypertensionUS Preventive Services Task Force Recommendation Statement

PrehypertensionOutpatient BP

Home BPEvery year

ABPMif expected risk MH or

large CV risk

Conformation of MH

Medical treatment on time

Confirmation with ABPM

Treat or not to treat prehypertension this is the question now

bull lifestyle modification for those with prehypertension-the good news is that it works

Ideal cardiovascular health behaviors and factors prevent the development of hypertension inprehypertensive subjects

Gao J Sun H Liang X Gao M Zhao H Qi Y Wang Y Liu Y Li J Zhu Y Zhao Y Wang W Ma L Wu SClinical amp Experimental Hypertension (New York) 37(8)650-5 2015

bull BACKGROUND Seven ideal health metrics were defined by AHA to monitor cardiovascular health This study aimed to investigate the impact of ideal cardiovascular health behaviors and factors on the development of hypertension in prehypertensive subjects

METHODS Thirty-two thousand eight-hundred and eighty-seven participants with prehypertension were included in the study after excluding for preexisting stroke myocardial infarction or malignancy Cox proportional hazards regression was used to calculate hazard ratios and 95 confidence intervals [CI] for the development of hypertension

RESULTS During a follow-up of 522 months 15500 prehypertensive participants developed hypertension The cumulative incidence of hypertension decreased with the number of ideal health metrics increased It was 7861 7108 6315 5607 and 6162 in prehypertensive individuals carrying lt 1 2 3 4 and gt 5 ideal health behaviors or factors respectively After adjustment for age gender family history of hypertension alcohol consumption resting heart rate plasma triglyceride high-density lipoprotein cholesterol low-density lipoprotein cholesterol and high-sensitivity C-reactive protein the risk ratios of incident hypertension in the subjects who carried 2 3 4 and gt 5 ideal health metrics were 0833 (95CI 0789-0880) 0710 (95CI 0672-0749) 0604 (95CI 0568-0642) and 0581 (95CI 0524-0643) respectively in comparison to those with lt 1 ideal health metric A similar trend was also observed in male and female populations Poor health metrics including body mass index diet (salt intake) physical activity total cholesterol and smoking were predictors for the development of hypertension in prehypertensive individuals

CONCLUSION Ideal cardiovascular health behaviors and factors are protective factors to prevent the progression from prehypertension to hypertension

IDACO HRs (vs NT) associated with masked HT

NT 2527 67 2527 14

NT with masked HT 112 10 112 4

Pre-HT with masked HT 672 74 672 27

No ofsubjects

No ofevents

No ofsubjects

No ofevents

CV events Stroke

05 1 2 4 8 05 1 2 4 8

24h BP thresholds ge13080 mmHg

258 (p=00032)

213 (plt00001)

418 (p=00047)

317 (plt00001)

Brguljan-Hitij J Thijs L Li Y et all Am J Hypertens 2014 Feb 26

Home blood pressure and ABPM in detecting masked hypertension (same sample N=128 )

CV riskUpgraded 117Downgraded 148No change 734

Masked hypertensionHome BPM748ABPM 131

MH = masked hypertensionNR = normotensionSH = sustained hypertension

RISHO2014

Baseline to follow-up reproducibility of home blood pressure measurements in tertiles of the follow up duration

RISHO2014

100 120 140 160

-40

-20

0

20

40

CR=176

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=161

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=198

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=218

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=212

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=242

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

a) 1tertile

b) 2tertile

c) 3tertile

Bland and Altman method CR=coefficient of reproducibility twice of SD of the difference between repeated measurement

Observation 24y

43y

59y

Home Blood Pressure as a Predictor of Future Blood Pressure Stability in Borderline HypertensionThe Tecumseh StudyS D Nesbitt J V Amerena EGrant K A Jamerson H Lu A Weder Stevo Julius

JAMA 2016315(23)2564-2575

Characteristics of Colorectal Cancer Screening Strategiesa

Screening for Colorectal Cancer vs ABPM in PrehypertensionUS Preventive Services Task Force Recommendation Statement

PrehypertensionOutpatient BP

Home BPEvery year

ABPMif expected risk MH or

large CV risk

Conformation of MH

Medical treatment on time

Confirmation with ABPM

Treat or not to treat prehypertension this is the question now

bull lifestyle modification for those with prehypertension-the good news is that it works

Ideal cardiovascular health behaviors and factors prevent the development of hypertension inprehypertensive subjects

Gao J Sun H Liang X Gao M Zhao H Qi Y Wang Y Liu Y Li J Zhu Y Zhao Y Wang W Ma L Wu SClinical amp Experimental Hypertension (New York) 37(8)650-5 2015

bull BACKGROUND Seven ideal health metrics were defined by AHA to monitor cardiovascular health This study aimed to investigate the impact of ideal cardiovascular health behaviors and factors on the development of hypertension in prehypertensive subjects

METHODS Thirty-two thousand eight-hundred and eighty-seven participants with prehypertension were included in the study after excluding for preexisting stroke myocardial infarction or malignancy Cox proportional hazards regression was used to calculate hazard ratios and 95 confidence intervals [CI] for the development of hypertension

RESULTS During a follow-up of 522 months 15500 prehypertensive participants developed hypertension The cumulative incidence of hypertension decreased with the number of ideal health metrics increased It was 7861 7108 6315 5607 and 6162 in prehypertensive individuals carrying lt 1 2 3 4 and gt 5 ideal health behaviors or factors respectively After adjustment for age gender family history of hypertension alcohol consumption resting heart rate plasma triglyceride high-density lipoprotein cholesterol low-density lipoprotein cholesterol and high-sensitivity C-reactive protein the risk ratios of incident hypertension in the subjects who carried 2 3 4 and gt 5 ideal health metrics were 0833 (95CI 0789-0880) 0710 (95CI 0672-0749) 0604 (95CI 0568-0642) and 0581 (95CI 0524-0643) respectively in comparison to those with lt 1 ideal health metric A similar trend was also observed in male and female populations Poor health metrics including body mass index diet (salt intake) physical activity total cholesterol and smoking were predictors for the development of hypertension in prehypertensive individuals

CONCLUSION Ideal cardiovascular health behaviors and factors are protective factors to prevent the progression from prehypertension to hypertension

Home blood pressure and ABPM in detecting masked hypertension (same sample N=128 )

CV riskUpgraded 117Downgraded 148No change 734

Masked hypertensionHome BPM748ABPM 131

MH = masked hypertensionNR = normotensionSH = sustained hypertension

RISHO2014

Baseline to follow-up reproducibility of home blood pressure measurements in tertiles of the follow up duration

RISHO2014

100 120 140 160

-40

-20

0

20

40

CR=176

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=161

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=198

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=218

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=212

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=242

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

a) 1tertile

b) 2tertile

c) 3tertile

Bland and Altman method CR=coefficient of reproducibility twice of SD of the difference between repeated measurement

Observation 24y

43y

59y

Home Blood Pressure as a Predictor of Future Blood Pressure Stability in Borderline HypertensionThe Tecumseh StudyS D Nesbitt J V Amerena EGrant K A Jamerson H Lu A Weder Stevo Julius

JAMA 2016315(23)2564-2575

Characteristics of Colorectal Cancer Screening Strategiesa

Screening for Colorectal Cancer vs ABPM in PrehypertensionUS Preventive Services Task Force Recommendation Statement

PrehypertensionOutpatient BP

Home BPEvery year

ABPMif expected risk MH or

large CV risk

Conformation of MH

Medical treatment on time

Confirmation with ABPM

Treat or not to treat prehypertension this is the question now

bull lifestyle modification for those with prehypertension-the good news is that it works

Ideal cardiovascular health behaviors and factors prevent the development of hypertension inprehypertensive subjects

Gao J Sun H Liang X Gao M Zhao H Qi Y Wang Y Liu Y Li J Zhu Y Zhao Y Wang W Ma L Wu SClinical amp Experimental Hypertension (New York) 37(8)650-5 2015

bull BACKGROUND Seven ideal health metrics were defined by AHA to monitor cardiovascular health This study aimed to investigate the impact of ideal cardiovascular health behaviors and factors on the development of hypertension in prehypertensive subjects

METHODS Thirty-two thousand eight-hundred and eighty-seven participants with prehypertension were included in the study after excluding for preexisting stroke myocardial infarction or malignancy Cox proportional hazards regression was used to calculate hazard ratios and 95 confidence intervals [CI] for the development of hypertension

RESULTS During a follow-up of 522 months 15500 prehypertensive participants developed hypertension The cumulative incidence of hypertension decreased with the number of ideal health metrics increased It was 7861 7108 6315 5607 and 6162 in prehypertensive individuals carrying lt 1 2 3 4 and gt 5 ideal health behaviors or factors respectively After adjustment for age gender family history of hypertension alcohol consumption resting heart rate plasma triglyceride high-density lipoprotein cholesterol low-density lipoprotein cholesterol and high-sensitivity C-reactive protein the risk ratios of incident hypertension in the subjects who carried 2 3 4 and gt 5 ideal health metrics were 0833 (95CI 0789-0880) 0710 (95CI 0672-0749) 0604 (95CI 0568-0642) and 0581 (95CI 0524-0643) respectively in comparison to those with lt 1 ideal health metric A similar trend was also observed in male and female populations Poor health metrics including body mass index diet (salt intake) physical activity total cholesterol and smoking were predictors for the development of hypertension in prehypertensive individuals

CONCLUSION Ideal cardiovascular health behaviors and factors are protective factors to prevent the progression from prehypertension to hypertension

Baseline to follow-up reproducibility of home blood pressure measurements in tertiles of the follow up duration

RISHO2014

100 120 140 160

-40

-20

0

20

40

CR=176

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=161

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=198

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=218

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

100 120 140 160

-40

-20

0

20

40

CR=212

Average home SBP

(mmHg)

h

om

e S

BP

(mm

Hg

)

60 80 100 120

-40

-20

0

20

40

CR=242

Average home DBP

(mmHg)

h

om

e D

BP

(mm

Hg

)

a) 1tertile

b) 2tertile

c) 3tertile

Bland and Altman method CR=coefficient of reproducibility twice of SD of the difference between repeated measurement

Observation 24y

43y

59y

Home Blood Pressure as a Predictor of Future Blood Pressure Stability in Borderline HypertensionThe Tecumseh StudyS D Nesbitt J V Amerena EGrant K A Jamerson H Lu A Weder Stevo Julius

JAMA 2016315(23)2564-2575

Characteristics of Colorectal Cancer Screening Strategiesa

Screening for Colorectal Cancer vs ABPM in PrehypertensionUS Preventive Services Task Force Recommendation Statement

PrehypertensionOutpatient BP

Home BPEvery year

ABPMif expected risk MH or

large CV risk

Conformation of MH

Medical treatment on time

Confirmation with ABPM

Treat or not to treat prehypertension this is the question now

bull lifestyle modification for those with prehypertension-the good news is that it works

Ideal cardiovascular health behaviors and factors prevent the development of hypertension inprehypertensive subjects

Gao J Sun H Liang X Gao M Zhao H Qi Y Wang Y Liu Y Li J Zhu Y Zhao Y Wang W Ma L Wu SClinical amp Experimental Hypertension (New York) 37(8)650-5 2015

bull BACKGROUND Seven ideal health metrics were defined by AHA to monitor cardiovascular health This study aimed to investigate the impact of ideal cardiovascular health behaviors and factors on the development of hypertension in prehypertensive subjects

METHODS Thirty-two thousand eight-hundred and eighty-seven participants with prehypertension were included in the study after excluding for preexisting stroke myocardial infarction or malignancy Cox proportional hazards regression was used to calculate hazard ratios and 95 confidence intervals [CI] for the development of hypertension

RESULTS During a follow-up of 522 months 15500 prehypertensive participants developed hypertension The cumulative incidence of hypertension decreased with the number of ideal health metrics increased It was 7861 7108 6315 5607 and 6162 in prehypertensive individuals carrying lt 1 2 3 4 and gt 5 ideal health behaviors or factors respectively After adjustment for age gender family history of hypertension alcohol consumption resting heart rate plasma triglyceride high-density lipoprotein cholesterol low-density lipoprotein cholesterol and high-sensitivity C-reactive protein the risk ratios of incident hypertension in the subjects who carried 2 3 4 and gt 5 ideal health metrics were 0833 (95CI 0789-0880) 0710 (95CI 0672-0749) 0604 (95CI 0568-0642) and 0581 (95CI 0524-0643) respectively in comparison to those with lt 1 ideal health metric A similar trend was also observed in male and female populations Poor health metrics including body mass index diet (salt intake) physical activity total cholesterol and smoking were predictors for the development of hypertension in prehypertensive individuals

CONCLUSION Ideal cardiovascular health behaviors and factors are protective factors to prevent the progression from prehypertension to hypertension

Home Blood Pressure as a Predictor of Future Blood Pressure Stability in Borderline HypertensionThe Tecumseh StudyS D Nesbitt J V Amerena EGrant K A Jamerson H Lu A Weder Stevo Julius

JAMA 2016315(23)2564-2575

Characteristics of Colorectal Cancer Screening Strategiesa

Screening for Colorectal Cancer vs ABPM in PrehypertensionUS Preventive Services Task Force Recommendation Statement

PrehypertensionOutpatient BP

Home BPEvery year

ABPMif expected risk MH or

large CV risk

Conformation of MH

Medical treatment on time

Confirmation with ABPM

Treat or not to treat prehypertension this is the question now

bull lifestyle modification for those with prehypertension-the good news is that it works

Ideal cardiovascular health behaviors and factors prevent the development of hypertension inprehypertensive subjects

Gao J Sun H Liang X Gao M Zhao H Qi Y Wang Y Liu Y Li J Zhu Y Zhao Y Wang W Ma L Wu SClinical amp Experimental Hypertension (New York) 37(8)650-5 2015

bull BACKGROUND Seven ideal health metrics were defined by AHA to monitor cardiovascular health This study aimed to investigate the impact of ideal cardiovascular health behaviors and factors on the development of hypertension in prehypertensive subjects

METHODS Thirty-two thousand eight-hundred and eighty-seven participants with prehypertension were included in the study after excluding for preexisting stroke myocardial infarction or malignancy Cox proportional hazards regression was used to calculate hazard ratios and 95 confidence intervals [CI] for the development of hypertension

RESULTS During a follow-up of 522 months 15500 prehypertensive participants developed hypertension The cumulative incidence of hypertension decreased with the number of ideal health metrics increased It was 7861 7108 6315 5607 and 6162 in prehypertensive individuals carrying lt 1 2 3 4 and gt 5 ideal health behaviors or factors respectively After adjustment for age gender family history of hypertension alcohol consumption resting heart rate plasma triglyceride high-density lipoprotein cholesterol low-density lipoprotein cholesterol and high-sensitivity C-reactive protein the risk ratios of incident hypertension in the subjects who carried 2 3 4 and gt 5 ideal health metrics were 0833 (95CI 0789-0880) 0710 (95CI 0672-0749) 0604 (95CI 0568-0642) and 0581 (95CI 0524-0643) respectively in comparison to those with lt 1 ideal health metric A similar trend was also observed in male and female populations Poor health metrics including body mass index diet (salt intake) physical activity total cholesterol and smoking were predictors for the development of hypertension in prehypertensive individuals

CONCLUSION Ideal cardiovascular health behaviors and factors are protective factors to prevent the progression from prehypertension to hypertension

JAMA 2016315(23)2564-2575

Characteristics of Colorectal Cancer Screening Strategiesa

Screening for Colorectal Cancer vs ABPM in PrehypertensionUS Preventive Services Task Force Recommendation Statement

PrehypertensionOutpatient BP

Home BPEvery year

ABPMif expected risk MH or

large CV risk

Conformation of MH

Medical treatment on time

Confirmation with ABPM

Treat or not to treat prehypertension this is the question now

bull lifestyle modification for those with prehypertension-the good news is that it works

Ideal cardiovascular health behaviors and factors prevent the development of hypertension inprehypertensive subjects

Gao J Sun H Liang X Gao M Zhao H Qi Y Wang Y Liu Y Li J Zhu Y Zhao Y Wang W Ma L Wu SClinical amp Experimental Hypertension (New York) 37(8)650-5 2015

bull BACKGROUND Seven ideal health metrics were defined by AHA to monitor cardiovascular health This study aimed to investigate the impact of ideal cardiovascular health behaviors and factors on the development of hypertension in prehypertensive subjects

METHODS Thirty-two thousand eight-hundred and eighty-seven participants with prehypertension were included in the study after excluding for preexisting stroke myocardial infarction or malignancy Cox proportional hazards regression was used to calculate hazard ratios and 95 confidence intervals [CI] for the development of hypertension

RESULTS During a follow-up of 522 months 15500 prehypertensive participants developed hypertension The cumulative incidence of hypertension decreased with the number of ideal health metrics increased It was 7861 7108 6315 5607 and 6162 in prehypertensive individuals carrying lt 1 2 3 4 and gt 5 ideal health behaviors or factors respectively After adjustment for age gender family history of hypertension alcohol consumption resting heart rate plasma triglyceride high-density lipoprotein cholesterol low-density lipoprotein cholesterol and high-sensitivity C-reactive protein the risk ratios of incident hypertension in the subjects who carried 2 3 4 and gt 5 ideal health metrics were 0833 (95CI 0789-0880) 0710 (95CI 0672-0749) 0604 (95CI 0568-0642) and 0581 (95CI 0524-0643) respectively in comparison to those with lt 1 ideal health metric A similar trend was also observed in male and female populations Poor health metrics including body mass index diet (salt intake) physical activity total cholesterol and smoking were predictors for the development of hypertension in prehypertensive individuals

CONCLUSION Ideal cardiovascular health behaviors and factors are protective factors to prevent the progression from prehypertension to hypertension

Treat or not to treat prehypertension this is the question now

bull lifestyle modification for those with prehypertension-the good news is that it works

Ideal cardiovascular health behaviors and factors prevent the development of hypertension inprehypertensive subjects

Gao J Sun H Liang X Gao M Zhao H Qi Y Wang Y Liu Y Li J Zhu Y Zhao Y Wang W Ma L Wu SClinical amp Experimental Hypertension (New York) 37(8)650-5 2015

bull BACKGROUND Seven ideal health metrics were defined by AHA to monitor cardiovascular health This study aimed to investigate the impact of ideal cardiovascular health behaviors and factors on the development of hypertension in prehypertensive subjects

METHODS Thirty-two thousand eight-hundred and eighty-seven participants with prehypertension were included in the study after excluding for preexisting stroke myocardial infarction or malignancy Cox proportional hazards regression was used to calculate hazard ratios and 95 confidence intervals [CI] for the development of hypertension

RESULTS During a follow-up of 522 months 15500 prehypertensive participants developed hypertension The cumulative incidence of hypertension decreased with the number of ideal health metrics increased It was 7861 7108 6315 5607 and 6162 in prehypertensive individuals carrying lt 1 2 3 4 and gt 5 ideal health behaviors or factors respectively After adjustment for age gender family history of hypertension alcohol consumption resting heart rate plasma triglyceride high-density lipoprotein cholesterol low-density lipoprotein cholesterol and high-sensitivity C-reactive protein the risk ratios of incident hypertension in the subjects who carried 2 3 4 and gt 5 ideal health metrics were 0833 (95CI 0789-0880) 0710 (95CI 0672-0749) 0604 (95CI 0568-0642) and 0581 (95CI 0524-0643) respectively in comparison to those with lt 1 ideal health metric A similar trend was also observed in male and female populations Poor health metrics including body mass index diet (salt intake) physical activity total cholesterol and smoking were predictors for the development of hypertension in prehypertensive individuals

CONCLUSION Ideal cardiovascular health behaviors and factors are protective factors to prevent the progression from prehypertension to hypertension

Ideal cardiovascular health behaviors and factors prevent the development of hypertension inprehypertensive subjects

Gao J Sun H Liang X Gao M Zhao H Qi Y Wang Y Liu Y Li J Zhu Y Zhao Y Wang W Ma L Wu SClinical amp Experimental Hypertension (New York) 37(8)650-5 2015

bull BACKGROUND Seven ideal health metrics were defined by AHA to monitor cardiovascular health This study aimed to investigate the impact of ideal cardiovascular health behaviors and factors on the development of hypertension in prehypertensive subjects

METHODS Thirty-two thousand eight-hundred and eighty-seven participants with prehypertension were included in the study after excluding for preexisting stroke myocardial infarction or malignancy Cox proportional hazards regression was used to calculate hazard ratios and 95 confidence intervals [CI] for the development of hypertension

RESULTS During a follow-up of 522 months 15500 prehypertensive participants developed hypertension The cumulative incidence of hypertension decreased with the number of ideal health metrics increased It was 7861 7108 6315 5607 and 6162 in prehypertensive individuals carrying lt 1 2 3 4 and gt 5 ideal health behaviors or factors respectively After adjustment for age gender family history of hypertension alcohol consumption resting heart rate plasma triglyceride high-density lipoprotein cholesterol low-density lipoprotein cholesterol and high-sensitivity C-reactive protein the risk ratios of incident hypertension in the subjects who carried 2 3 4 and gt 5 ideal health metrics were 0833 (95CI 0789-0880) 0710 (95CI 0672-0749) 0604 (95CI 0568-0642) and 0581 (95CI 0524-0643) respectively in comparison to those with lt 1 ideal health metric A similar trend was also observed in male and female populations Poor health metrics including body mass index diet (salt intake) physical activity total cholesterol and smoking were predictors for the development of hypertension in prehypertensive individuals

CONCLUSION Ideal cardiovascular health behaviors and factors are protective factors to prevent the progression from prehypertension to hypertension

Treat or not to treat prehypertension this is the question now

bull ProfBakris

bull The argument has always been to use lifestyle modification for those with prehypertension-the good news is that it works but the bad news is that nobody does it

How does story continue

bull TROPHY study (candesartan) Julius S Nesbitt SD Egan BM et al Feasibility of treating prehypertension with an angiotensin-receptor blocker N Engl J Med2006354(16)1685-1697

bull PHARAO study (Ramipril) Luumlders S Schrader J Berger J et al The PHARAO study prevention of hypertension with the angiotensin-converting enzyme inhibitor ramipril in patients with high-normal blood pressure a prospective randomized controlled prevention trial of the German Hypertension League J Hypertens 200826(7)1487-1496

bull Small studies no effect

TROPHY studyKaplan-Meier Curves of New Onset of Clinical

Hypertension in the Two Groups

0 1 2 3 4

Years in study

0

01

02

03

04

05

06

07

08

09

10

C

um

ula

tive

inci

den

ce

Candesartan

Placebo

Candesartan 391 356 309 191 128

Placebo 381 269 184 118 85

Numbers under the graph refer to hypertension-free individuals

2 YearsRR darr66AR darr 26

4 YearsRR darr158AR darr 96

P lt 00001

Julius S NesbittSD N Engl J Med 20063541-13

No effect

bull Lowering the tresholds for the initiation of pharmacologic therapy would have a tremendous economic effect on public health care system (Grassi N Eng J Med 2006)

bull The high-risk strategy identifes and treats those at greatest risk (eg 10y coronary heart disease risk gt20) While there benefits individual the population attributale risk remains significant since most events occur among those at lower risk levels (Egan Nesbitt Julius Therapevtic Advances in CV Disease)

Conclusion for our practice

bull Prehypertension is not an innocent stage and could be dangerous condition

bull It needs to be monitorised excluded masked hypertension

bull Regular blood pressure measurements HBPM ABPM telemonitoring

bull Life style modification versus pharmacological treatment

bull Subclinical organ damage assessmentbull Medical treatment as soon as it is needed

according present ESH guidelines

How does story continue

bull TROPHY study (candesartan) Julius S Nesbitt SD Egan BM et al Feasibility of treating prehypertension with an angiotensin-receptor blocker N Engl J Med2006354(16)1685-1697

bull PHARAO study (Ramipril) Luumlders S Schrader J Berger J et al The PHARAO study prevention of hypertension with the angiotensin-converting enzyme inhibitor ramipril in patients with high-normal blood pressure a prospective randomized controlled prevention trial of the German Hypertension League J Hypertens 200826(7)1487-1496

bull Small studies no effect

TROPHY studyKaplan-Meier Curves of New Onset of Clinical

Hypertension in the Two Groups

0 1 2 3 4

Years in study

0

01

02

03

04

05

06

07

08

09

10

C

um

ula

tive

inci

den

ce

Candesartan

Placebo

Candesartan 391 356 309 191 128

Placebo 381 269 184 118 85

Numbers under the graph refer to hypertension-free individuals

2 YearsRR darr66AR darr 26

4 YearsRR darr158AR darr 96

P lt 00001

Julius S NesbittSD N Engl J Med 20063541-13

No effect

bull Lowering the tresholds for the initiation of pharmacologic therapy would have a tremendous economic effect on public health care system (Grassi N Eng J Med 2006)

bull The high-risk strategy identifes and treats those at greatest risk (eg 10y coronary heart disease risk gt20) While there benefits individual the population attributale risk remains significant since most events occur among those at lower risk levels (Egan Nesbitt Julius Therapevtic Advances in CV Disease)

Conclusion for our practice

bull Prehypertension is not an innocent stage and could be dangerous condition

bull It needs to be monitorised excluded masked hypertension

bull Regular blood pressure measurements HBPM ABPM telemonitoring

bull Life style modification versus pharmacological treatment

bull Subclinical organ damage assessmentbull Medical treatment as soon as it is needed

according present ESH guidelines

TROPHY studyKaplan-Meier Curves of New Onset of Clinical

Hypertension in the Two Groups

0 1 2 3 4

Years in study

0

01

02

03

04

05

06

07

08

09

10

C

um

ula

tive

inci

den

ce

Candesartan

Placebo

Candesartan 391 356 309 191 128

Placebo 381 269 184 118 85

Numbers under the graph refer to hypertension-free individuals

2 YearsRR darr66AR darr 26

4 YearsRR darr158AR darr 96

P lt 00001

Julius S NesbittSD N Engl J Med 20063541-13

No effect

bull Lowering the tresholds for the initiation of pharmacologic therapy would have a tremendous economic effect on public health care system (Grassi N Eng J Med 2006)

bull The high-risk strategy identifes and treats those at greatest risk (eg 10y coronary heart disease risk gt20) While there benefits individual the population attributale risk remains significant since most events occur among those at lower risk levels (Egan Nesbitt Julius Therapevtic Advances in CV Disease)

Conclusion for our practice

bull Prehypertension is not an innocent stage and could be dangerous condition

bull It needs to be monitorised excluded masked hypertension

bull Regular blood pressure measurements HBPM ABPM telemonitoring

bull Life style modification versus pharmacological treatment

bull Subclinical organ damage assessmentbull Medical treatment as soon as it is needed

according present ESH guidelines

No effect

bull Lowering the tresholds for the initiation of pharmacologic therapy would have a tremendous economic effect on public health care system (Grassi N Eng J Med 2006)

bull The high-risk strategy identifes and treats those at greatest risk (eg 10y coronary heart disease risk gt20) While there benefits individual the population attributale risk remains significant since most events occur among those at lower risk levels (Egan Nesbitt Julius Therapevtic Advances in CV Disease)

Conclusion for our practice

bull Prehypertension is not an innocent stage and could be dangerous condition

bull It needs to be monitorised excluded masked hypertension

bull Regular blood pressure measurements HBPM ABPM telemonitoring

bull Life style modification versus pharmacological treatment

bull Subclinical organ damage assessmentbull Medical treatment as soon as it is needed

according present ESH guidelines

bull Lowering the tresholds for the initiation of pharmacologic therapy would have a tremendous economic effect on public health care system (Grassi N Eng J Med 2006)

bull The high-risk strategy identifes and treats those at greatest risk (eg 10y coronary heart disease risk gt20) While there benefits individual the population attributale risk remains significant since most events occur among those at lower risk levels (Egan Nesbitt Julius Therapevtic Advances in CV Disease)

Conclusion for our practice

bull Prehypertension is not an innocent stage and could be dangerous condition

bull It needs to be monitorised excluded masked hypertension

bull Regular blood pressure measurements HBPM ABPM telemonitoring

bull Life style modification versus pharmacological treatment

bull Subclinical organ damage assessmentbull Medical treatment as soon as it is needed

according present ESH guidelines

Conclusion for our practice

bull Prehypertension is not an innocent stage and could be dangerous condition

bull It needs to be monitorised excluded masked hypertension

bull Regular blood pressure measurements HBPM ABPM telemonitoring

bull Life style modification versus pharmacological treatment

bull Subclinical organ damage assessmentbull Medical treatment as soon as it is needed

according present ESH guidelines