Opposing age-related trends in absolute and relative risk of adverse health outcomes associated with out-of-office blood pressure

Yan Li, Lutgarde Thijs, Zhen Yu Zhang, Kei Asayama, Tine W. Hansen, José Boggia, Kristina Björklund-Bodegård, Wen Yi Yang, Teemu J. Niiranen, Angeliki Ntineri, Fang Fei Wei, Masahiro Kikuya, Takayoshi Ohkubo, Eamon Dolan, Atsushi Hozawa, Ichiro Tsuji, Katarzyna Stolarz-Skrzypek, Qi Fang Huang, Jesus D. Melgarejo, Valérie TikhonoffSofia Malyutina, Edoardo Casiglia, Yuri Nikitin, Lars Lind, Edgardo Sandoya, Lucas Aparicio, Jessica Barochiner, Natasza Gilis-Malinowska, Krzysztof Narkiewicz, Kalina Kawecka-Jaszcz, Gladys E. Maestre, Antti M. Jula, Jouni K. Johansson, Tatiana Kuznetsova, Jan Filipovský, George Stergiou, Ji Guang Wang, Yutaka Imai, Eoin O'Brien, Jan A. Staessen

Research output: Contribution to journalArticlepeer-review

26 Citations (Scopus)


Participant-level meta-analyses assessed the age-specific relevance of office blood pressure to cardiovascular complications, but this information is lacking for out-of-office blood pressure. At baseline, daytime ambulatory (n=12 624) or home (n=5297) blood pressure were measured in 17 921 participants (51.3% women; mean age, 54.2 years) from 17 population cohorts. Subsequently, mortality and cardiovascular events were recorded. Using multivariable Cox regression, floating absolute risk was computed across 4 age bands (≤60, 61-70, 71-80, and >80 years). Over 236 491 person-years, 3855 people died and 2942 cardiovascular events occurred. From levels as low as 110/65 mm Hg, risk log-linearly increased with higher out-of-office systolic/diastolic blood pressure. From the youngest to the oldest age group, rates expressed per 1000 person-years increased (P<0.001) from 4.4 (95% CI, 4.0-4.7) to 86.3 (76.1-96.5) for all-cause mortality and from 4.1 (3.9-4.6) to 59.8 (51.0-68.7) for cardiovascular events, whereas hazard ratios per 20-mm Hg increment in systolic out-of-office blood pressure decreased (P≤0.0033) from 1.42 (1.19-1.69) to 1.09 (1.05-1.12) and from 1.70 (1.51-1.92) to 1.12 (1.07-1.17), respectively. These age-related trends were similar for out-of-office diastolic pressure and were generally consistent in both sexes and across ethnicities. In conclusion, adverse outcomes were directly associated with out-of-office blood pressure in adults. At young age, the absolute risk associated with out-of-office blood pressure was low, but relative risk high, whereas with advancing age relative risk decreased and absolute risk increased. These observations highlight the need of a lifecourse approach for the management of hypertension.

Original languageEnglish
Pages (from-to)1333-1342
Number of pages10
Issue number6
Publication statusPublished - 2019 Dec 1


  • Ambulatory
  • Blood pressure
  • Blood pressure monitoring
  • Cardiovascular diseases
  • Hypertension
  • Mortality


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