Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension.

TLDR

The study prospectively followed 1187 hypertensive patients and 205 normotensive controls for up to 7.5 years to assess the prognostic value of ambulatory blood pressure. Baseline off‑therapy 24‑hour noninvasive ambulatory blood pressure monitoring was performed to classify subjects. White‑coat hypertension was present in 19.2% of subjects, and cardiovascular morbidity increased from 0.47 events per 100 patient‑years in normotensives to 1.79 in dippers and 4.99 in nondippers with ambulatory hypertension, with nondippers exhibiting a 6.26‑fold higher risk than white‑coat hypertensives and remaining significant after adjustment for traditional risk markers. Abstract truncated at 250 words.

Abstract

To determine the prognostic significance of ambulatory blood pressure, we prospectively followed for up to 7.5 years (mean, 3.2) 1187 subjects with essential hypertension and 205 healthy normotensive control subjects who had baseline off-therapy 24-hour noninvasive ambulatory blood pressure monitoring. Prevalence of white coat hypertension, defined by an average daytime ambulatory blood pressure lower than 131/86 mm Hg in women and 136/87 mm Hg in men in clinically hypertensive subjects, was 19.2%. Cardiovascular morbidity, expressed as the number of combined fatal and nonfatal cardiovascular events per 100 patient-years, was 0.47 in the normotensive group, 0.49 in the white coat hypertension group, 1.79 in dippers with ambulatory hypertension, and 4.99 in nondippers with ambulatory hypertension. After adjustment for traditional risk markers for cardiovascular disease, morbidity did not differ between the normotensive and white coat hypertension groups (P = .83). Compared with the white coat hypertension group, cardiovascular morbidity increased in ambulatory hypertension in dippers (relative risk, 3.70; 95% confidence interval, 1.13 to 12.5), with a further increase of morbidity in nondippers (relative risk, 6.26; 95% confidence interval, 1.92 to 20.32). After adjustment for age, sex, diabetes, and echocardiographic left ventricular hypertrophy (relative risk versus subjects with normal left ventricular mass, 1.82; 95% confidence interval, 1.02 to 3.22), cardiovascular morbidity in ambulatory hypertension was higher (P = .0002) in nondippers than in dippers in women (relative risk, 6.79; 95% confidence interval, 2.45 to 18.82) but not in men (P = .91). Our findings suggest that ambulatory blood pressures stratifies cardiovascular risk in essential hypertension independent of clinic blood pressure and other traditional risk markers including echocardiographic left ventricular hypertrophy. (ABSTRACT TRUNCATED AT 250 WORDS)