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Abstract

Office blood pressure (BP) is not adequately controlled in many treated hypertensive patients. Prevalence and prognostic impact of ambulatory BP control are largely unknown.

In the setting of a prospective cohort study in hypertensive patients (PIUMA study), we evaluated the prognostic impact of office and ambulatory BP control in 759 patients with essential hypertension. Clinical data, including office and 24-hour ambulatory BP, were obtained before treatment and after an average of 3.6 years. Treatment was tailored to the single patient. At the follow-up visit, 27% of patients had adequate office BP control (< 140/90 mmHg) and 39% had adequate 24-hour ambulatory BP control (< 130/80 mmHg). During a follow-up period of up to 14 years, 55 patients experienced a first major cardiovascular event. Event rate did not differ significantly between patients with adequate or inadequate office BP control at the previous visit (0.97 vs 1.63 events x 100 patient-years; p = 0.24). In contrast, when BP control was assessed on the basis of 24-hour ambulatory BP, event rate was lower in well than in poorly controlled patients (0.90 vs 1.88 events x 100 patient-years; p = 0.02). After adjustment for age (p=0.002), diabetes (p=0.0003), and left ventricular hypertrophy (p=0.007), 24-ambulatory BP control was associated with a 60% lesser risk for subsequent cardiovascular disease (95% confidence intervals: 19-81%; p=0.011).

These findings indicate for the first time that ambulatory BP control is superior to office BP control for cardiovascular risk stratification in treated hypertensive patients.

Ambulatory Blood Pressure, Prognosis, Left Ventricular Hypertrophy
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© American Journal of Hypertension, Ltd. 2001
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