Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension.

BACKGROUND It is uncertain whether ambulatory blood-pressure measurements recorded for 24 hours in patients with treated hypertension predict cardiovascular events independently of blood-pressure measurements obtained in the physician's office and other cardiovascular risk factors. METHODS We assessed the association between base-line ambulatory blood pressures in treated patients and subsequent cardiovascular events among 1963 patients with a median follow-up of 5 years (range, 1 to 66 months). RESULTS We documented new cardiovascular events in 157 patients. In a Cox proportional-hazards model with adjustment for age, sex, smoking status, presence or absence of diabetes mellitus, serum cholesterol concentration, body-mass index, use or nonuse of lipid-lowering drugs, and presence or absence of a history of cardiovascular events, as well as blood pressure measured at the physician's office, higher mean values for 24-hour ambulatory systolic and diastolic blood pressure were independent risk factors for new cardiovascular events. The adjusted relative risk of cardiovascular events associated with a 1-SD increment in blood pressure was 1.34 (95 percent confidence interval, 1.11 to 1.62) for 24-hour ambulatory systolic blood pressure, 1.30 (95 percent confidence interval, 1.08 to 1.58) for ambulatory systolic blood pressure during the daytime, and 1.27 (95 percent confidence interval, 1.07 to 1.57) for ambulatory systolic blood pressure during the nighttime. For ambulatory diastolic blood pressure, the corresponding relative risks of cardiovascular events associated with a 1-SD increment were 1.21 (95 percent confidence interval, 1.01 to 1.46), 1.24 (95 percent confidence interval, 1.03 to 1.49), and 1.18 (95 percent confidence interval, 0.98 to 1.40). CONCLUSIONS In patients with treated hypertension, a higher ambulatory systolic or diastolic blood pressure predicts cardiovascular events even after adjustment for classic risk factors including office measurements of blood pressure.

[1]  Daniel W. Jones,et al.  The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. , 2003, JAMA.

[2]  M. Kikuya,et al.  Prognostic significance of the nocturnal decline in blood pressure in individuals with and without high 24-h blood pressure: the Ohasama study , 2002, Journal of hypertension.

[3]  G. Mancia,et al.  Systolic vs diastolic blood pressure control in the hypertensive patients of the PAMELA population. Pressioni Arteriose Monitorate E Loro Associazioni. , 2002, Archives of internal medicine.

[4]  S. Pede,et al.  Risk of cardiovascular disease in relation to achieved office and ambulatory blood pressure control in treated hypertensive subjects. , 2002, Journal of the American College of Cardiology.

[5]  Daniel Duprez,et al.  The prognostic value of ambulatory blood pressure in treated hypertension: the office versus ambulatory (OvA) blood pressure study , 2002 .

[6]  J E Schwartz,et al.  Stroke Prognosis and Abnormal Nocturnal Blood Pressure Falls in Older Hypertensives , 2001, Hypertension.

[7]  B. Conrad,et al.  Relationship Between Circadian Blood Pressure Patterns and Progression of Early Carotid Atherosclerosis: A 3-Year Follow-Up Study , 2000, Circulation.

[8]  J D Swales,et al.  Prediction of coronary and cerebrovascular morbidity and mortality by direct continuous ambulatory blood pressure monitoring in essential hypertension. , 1999, Circulation.

[9]  Gianfranco Parati,et al.  Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. , 1999 .

[10]  C. Doré,et al.  Prediction of coronary and cerebrovascular morbidity and mortality by direct continuous ambulatory blood pressure monitoring in essential hypertension (vol 100, pg 1071, 1999) , 1999 .

[11]  S. Pede,et al.  Ambulatory pulse pressure: a potent predictor of total cardiovascular risk in hypertension. , 1998, Hypertension.

[12]  T. Kigoshi,et al.  Reversed circadian blood pressure rhythm is associated with occurrences of both fatal and nonfatal vascular events in NIDDM subjects. , 1998, Diabetes.

[13]  K Nagai,et al.  Reference values for 24-hour ambulatory blood pressure monitoring based on a prognostic criterion: the Ohasama Study. , 1998, Hypertension.

[14]  M. Kornitzer,et al.  Trends in the prevalence, detection, treatment and control of arterial hypertension in the Belgian adult population , 1998, Journal of hypertension.

[15]  J. Kimura,et al.  Adverse effect of nighttime blood pressure on the outcome of lacunar infarct patients. , 1998, Stroke.

[16]  E. O’Brien,et al.  Antihypertensive treatment based on conventional or ambulatory blood pressure measurement. A randomized controlled trial. Ambulatory Blood Pressure Monitoring and Treatment of Hypertension Investigators. , 1997, JAMA.

[17]  Jan A Staessen,et al.  Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension , 1997, The Lancet.

[18]  L. Ruilope,et al.  Prognostic value of ambulatory blood pressure monitoring in refractory hypertension , 1997 .

[19]  T. Ohkubo,et al.  Prediction of mortality by ambulatory blood pressure monitoring versus screening blood pressure measurements: a pilot study in Ohasama , 1997, Journal of hypertension.

[20]  R H Fagard,et al.  Prediction of cardiac structure and function by repeated clinic and ambulatory blood pressure. , 1997, Hypertension.

[21]  J. Staessen,et al.  Prediction of the actual awake and asleep blood pressures by various methods of 24 h pressure analysis , 1996, Journal of hypertension.

[22]  T. Pickering.  How should the diurnal changes of blood pressure be expressed? , 1995, American journal of hypertension.

[23]  G. Reboldi,et al.  Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension. , 1994, Hypertension.

[24]  W. Klein,et al.  "Non-dipping" related to cardiovascular events in essential hypertensive patients. , 1994, Acta medica Austriaca.

[25]  G. Schillaci,et al.  Blunted nocturnal fall in blood pressure in hypertensive women with future cardiovascular morbid events. , 1993, Circulation.

[26]  R. Juster,et al.  Prognostic value of ambulatory blood pressure measurements: further analyses. , 1989, Journal of hypertension. Supplement : official journal of the International Society of Hypertension.

[27]  D. English,et al.  Determinants of blood pressure in childhood and adolescence , 1989, Journal of hypertension. Supplement : official journal of the International Society of Hypertension.

[28]  E. O’Brien,et al.  DIPPERS AND NON-DIPPERS , 1988, The Lancet.

[29]  M. Sokolow,et al.  The prognostic value of ambulatory blood pressures. , 1983, JAMA.