Prognostic Value of Ambulatory and Home Blood Pressures Compared With Office Blood Pressure in the General Population

Abstract

Background-Studies in hypertensive patients suggest that ambulatory blood pressure (BP) is prognostically superior to office BP. Much less information is available in the general population, however. Obtaining this information was the purpose of the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study. Methods and Results-Office, home, and 24-hour ambulatory BP values were obtained in 2051 subjects between 25 and 74 years of age who were representative of the general population of Monza (Milan, Italy). Subjects were followed up for an average of 131 months, during which time cardiovascular and noncardiovascular fatal events were recorded (nϭ186). Office, home, and ambulatory BP values showed a significant exponential direct relationship with risk of cardiovascular or all-cause death. The goodness of fit of the relationship was greater for systolic than for diastolic BP and for night than for day BP, but its overall value was not better for home or ambulatory than for office BP. The slope of the relationship, however, was progressively greater from office to home and ambulatory BP. Home and night BP modestly improved the goodness of fit of the risk model when added to office BP. Conclusions-In the PAMELA population, risk of death increased more with a given increase in home or ambulatory than in office BP. The overall ability to predict death, however, was not greater for home and ambulatory than for office BP, although it was somewhat increased by the combination of office and outside-of-office values. Systolic BP was almost invariably superior to diastolic BP, and night BP was superior to day BP. (Circulation. 2005;111:1777-1783.)

Ambulatory pulse pressure as a novel predictor for long-term prognosis in essential hypertensive patients

“…15 Given the potential inaccuracies in measurement technique and artificial increases in BP produced by 'white-coat' effects, 2 office or clinic BP measurement could be inferior to ABPM in predicting hypertension-induced organ damage or clinical outcome. [3][4][5][6] In the current study, office BP parameters including SBP, DBP and even PP failed to predict any clinical outcome. On the other hand, ambulatory BP parameters such as 24 h, daytime and nighttime PP predicted not only CVD and mortality but also non-CV and all-cause mortality, suggesting their broad prognostic impacts in hypertensive patients.…”

“…2 Many studies have confirmed superiority of 24-h ambulatory BP monitoring (ABPM) over office or clinic BP measurement in predicting hypertension-induced organ damage or clinical outcome. [3][4][5][6] To what extent ABPM provides an independent predictive value beyond office BP is of clinical importance, as ABPM is potentially more burdensome and associated with higher costs than office or clinic BP measurements. Previous study mainly focused on ambulatory systolic BP (SBP) 3,4,6,7 or diastolic BP (DBP).…”

“…[3][4][5][6] To what extent ABPM provides an independent predictive value beyond office BP is of clinical importance, as ABPM is potentially more burdensome and associated with higher costs than office or clinic BP measurements. Previous study mainly focused on ambulatory systolic BP (SBP) 3,4,6,7 or diastolic BP (DBP). 3,4 Variation in the day-night BP pattern (the dipping status) has also been claimed as an important predictor of both target-organ damage and CV events.…”

“…3,4 Variation in the day-night BP pattern (the dipping status) has also been claimed as an important predictor of both target-organ damage and CV events. 4,6,8 However, the roles of other parameters derived from ABPM, including 24-h pulse pressure (PP), daytime PP and nighttime PP, are not fully defined. Further, previous studies were mainly conducted in Europe 3,4,6 and Japan.…”

“…4,6,8 However, the roles of other parameters derived from ABPM, including 24-h pulse pressure (PP), daytime PP and nighttime PP, are not fully defined. Further, previous studies were mainly conducted in Europe 3,4,6 and Japan. 5 Both environmental and genetic factors 9 of hypertension may be different among different ethic populations.…”