Average Daily Blood Pressure, Not Office Blood Pressure, Determines Cardiac Function in Patients With Hypertension

TLDR

The study prospectively examined three age‑matched groups of hypertensive patients defined by office and ambulatory blood pressures to assess cardiac disease presence. Patients were classified into office‑only hypertensives, normotensives, and daytime hypertensives using specific office and awake ambulatory thresholds. Patients with office‑only hypertension had left atrial and ventricular indices, filling rates, and exercise ejection fractions comparable to normotensives, whereas daytime hypertensives showed higher indices, indicating that average daily blood pressure predicts cardiac damage. JAMA 1989;261:873‑877.

Abstract

To determine the presence of cardiac disease in hypertensive patients with disparities between physician and out-of-office blood pressures, we prospectively studied three groups of age-matched patients identified by both casual (office) and ambulatory blood pressures: (1) office blood pressure greater than 140/90 mm Hg and awake ambulatory blood pressure of 130/80 mm Hg or less ("office" hypertensives); (2) office blood pressure less than 135/85 mm Hg and awake ambulatory blood pressure of 130/80 mm Hg or less (normotensives); and (3) office blood pressure greater than 140/90 mm Hg and awake ambulatory blood pressure of 140/90 mm Hg or greater ("daytime" hypertensives). In the patients with office hypertension, both the left atrial index and left ventricular mass index were significantly less than in patients with daytime hypertension and not statistically different from those of the normotensive subjects. Left ventricular filling rate at rest and ejection fraction at peak exercise were significantly greater in the office hypertensive group than in the daytime hypertensive group but were no different from those of the normotensive subjects. These findings demonstrate that patients with blood pressure elevation only in the physician's office have cardiac size and function similar to those of normotensive individuals. Thus, the average daily blood pressure best predicts cardiac end-organ damage. (<i>JAMA</i>1989;261:873-877)