(Hypertension. 2000;35:844.)
© 2000 American Heart Association, Inc.
Scientific Contributions |
Prognostic Value of Ambulatory Blood Pressure
Current Evidence and Clinical Implications
From the Ospedale R. Silvestrini, Dipartimento di Scienze Cardiologiche, Perugia PG, Italy.
Correspondence to Dr Paolo Verdecchia, Ospedale R Silvestrini, Dipartimento di Scienze Cardiologiche, 00156 Perugia PG, Italy. E-mail verdec{at}tin.it
Abstract—This article is a critical review of the available evidence on the prognostic value of ambulatory blood pressure (ABP). Several event-based cohort studies have shown that ABP improves cardiovascular risk stratification over and beyond traditional risk factors, including office BP. Most of these studies have been conducted in subjects with essential hypertension who were untreated at the time of execution of ABP monitoring; other studies have been conducted in subjects who were poorly controlled with treatment or in the general population. In these studies, ABP was examined as a continuous variable or with operational risk categories. Cardiovascular risk showed a direct and independent association with the observed ABP (systolic, diastolic, and pulse) and an inverse association with the degree of BP reduction from day to night. Cardiovascular risk was also directly associated with the difference between the observed value of ABP and that predicted from the office BP. White-coat hypertension versus ambulatory hypertension and dippers versus nondippers are 2 classifications based on arbitrary operational risk categories. A blunted or absent BP reduction from day to night, defined with ABP as a continuous variable or with operational thresholds, was also associated with a worse outcome regardless of the average value of ABP during the 24 hours. Overall, these studies indicate that ABP monitoring is particularly valuable to refine cardiovascular risk stratification in untreated subjects with office hypertension and in those with resistant hypertension. Intervention studies targeted at ABP are now needed.
Key Words: hypertension, arterial • hypertension, essential • hypertension, white-coat • blood pressure monitoring • stroke • myocardial infarction
This article has been cited by other articles:
 |
|
 |
|
  T. Unger The rationale for choosing telmisartan and ramipril in the ONTARGET programme Eur. Heart J. Suppl., December 1, 2009; 11(suppl_F): F3 - F8. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Parati, S. Omboni, and G. Bilo Why Is Out-of-Office Blood Pressure Measurement Needed?: Home Blood Pressure Measurements Will Increasingly Replace Ambulatory Blood Pressure Monitoring in the Diagnosis and Management of Hypertension Hypertension, August 1, 2009; 54(2): 181 - 187. [Full Text] [PDF]
|
|
|
|
|
|
P. Verdecchia, F. Angeli, G. Mazzotta, G. Gentile, and G. Reboldi Home Blood Pressure Measurements Will Not Replace 24-Hour Ambulatory Blood Pressure Monitoring Hypertension, August 1, 2009; 54(2): 188 - 195. [Full Text] [PDF]
|
|
|
|
 |
|
 E. S. Muxfeldt, C. R. L. Cardoso, and G. F. Salles Prognostic Value of Nocturnal Blood Pressure Reduction in Resistant Hypertension Arch Intern Med, May 11, 2009; 169(9): 874 - 880. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. K. Goldman, A. S. Azar, J. M. Mulvaney, C. Hinojosa-Laborde, J. R. Haywood, and V. L. Brooks Baroreflex sensitivity varies during the rat estrous cycle: role of gonadal steroids Am J Physiol Regulatory Integrative Comp Physiol, May 1, 2009; 296(5): R1419 - R1426. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.R Fernandez, R.C Hermida, and A Mojon Chronobiological analysis techniques. Application to blood pressure Phil Trans R Soc A, January 28, 2009; 367(1887): 431 - 445. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Delaney, M. Pellizzari, P. W. Speiser, and G. R. Frank Pitfalls in the Measurement of the Nocturnal Blood Pressure Dip in Adolescents with Type 1 Diabetes Diabetes Care, January 1, 2009; 32(1): 165 - 168. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Eguchi, T. G. Pickering, J. E. Schwartz, S. Hoshide, J. Ishikawa, S. Ishikawa, K. Shimada, and K. Kario Short Sleep Duration as an Independent Predictor of Cardiovascular Events in Japanese Patients With Hypertension Arch Intern Med, November 10, 2008; 168(20): 2225 - 2231. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. J Sommerfield, L. Robinson, P. L Padfield, and M. W. Strachan Clinical variables associated with non-dipping of nocturnal blood pressure in type 2 diabetes The British Journal of Diabetes & Vascular Disease, September 1, 2008; 8(5): 236 - 240. [Abstract] [PDF]
|
|
|
|
 |
|
 K. Chavanu, J. Merkel, and A. M. Quan Role of ambulatory blood pressure monitoring in the management of hypertension Am. J. Health Syst. Pharm., February 1, 2008; 65(3): 209 - 218. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. A. Flachskampf, J. Gallasch, O. Gefeller, J. Gan, J. Mao, A. B. Pfahlberg, A. Wortmann, L. Klinghammer, W. Pflederer, and W. G. Daniel Randomized Trial of Acupuncture to Lower Blood Pressure Circulation, June 19, 2007; 115(24): 3121 - 3129. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Verdecchia, F. Angeli, and C. Cavallini Ambulatory Blood Pressure for Cardiovascular Risk Stratification Circulation, April 24, 2007; 115(16): 2091 - 2093. [Full Text] [PDF]
|
|
|
|
|
|
P. Haentjens, A. Van Meerhaeghe, A. Moscariello, S. De Weerdt, K. Poppe, A. Dupont, and B. Velkeniers The Impact of Continuous Positive Airway Pressure on Blood Pressure in Patients With Obstructive Sleep Apnea Syndrome: Evidence From a Meta-analysis of Placebo-Controlled Randomized Trials Arch Intern Med, April 23, 2007; 167(8): 757 - 764. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Moriya, T. Ohtake, and S. Kobayashi Aortic stiffness, left ventricular hypertrophy and weekly averaged blood pressure (WAB) in patients on haemodialysis Nephrol. Dial. Transplant., April 1, 2007; 22(4): 1198 - 1204. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Verdecchia, F. Angeli, C. Borgioni, R. Gattobigio, and G. Reboldi Ambulatory Blood Pressure and Cardiovascular Outcome in Relation to Perceived Sleep Deprivation Hypertension, April 1, 2007; 49(4): 777 - 783. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Kokkinos, A. Pittaras, P. Narayan, C. Faselis, S. Singh, and A. Manolis Exercise Capacity and Blood Pressure Associations With Left Ventricular Mass in Prehypertensive Individuals Hypertension, January 1, 2007; 49(1): 55 - 61. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. C.K. Leung, D. K. Ng, M. W. Lau, C.-h. Chan, K.-l. Kwok, P.-y. Chow, and J. M.Y. Cheung Twenty-Four-Hour Ambulatory BP in Snoring Children With Obstructive Sleep Apnea Syndrome. Chest, October 1, 2006; 130(4): 1009 - 1017. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Schillaci, M. Pirro, M. R. Mannarino, G. Pucci, G. Savarese, S. S. Franklin, and E. Mannarino Relation Between Renal Function Within the Normal Range and Central and Peripheral Arterial Stiffness in Hypertension Hypertension, October 1, 2006; 48(4): 616 - 621. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Salles, C. Cardoso, A. R. Nogueira, K. Bloch, and E. Muxfeldt Importance of the Electrocardiographic Strain Pattern in Patients With Resistant Hypertension Hypertension, September 1, 2006; 48(3): 437 - 442. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. W. Braith and K. J. Stewart Resistance Exercise Training: Its Role in the Prevention of Cardiovascular Disease Circulation, June 6, 2006; 113(22): 2642 - 2650. [Full Text] [PDF]
|
|
|
|
 |
|
 T. G. Pickering, D. Shimbo, and D. Haas Ambulatory blood-pressure monitoring. N. Engl. J. Med., June 1, 2006; 354(22): 2368 - 2374. [Full Text] [PDF]
|
|
|
|
|
|
G. Mancia, R. Facchetti, M. Bombelli, G. Grassi, and R. Sega Long-Term Risk of Mortality Associated With Selective and Combined Elevation in Office, Home, and Ambulatory Blood Pressure Hypertension, May 1, 2006; 47(5): 846 - 853. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Verdecchia, F. Angeli, and J. A. Staessen Compared With Whom?: Addressing the Prognostic Value of Ambulatory Blood Pressure Categories Hypertension, May 1, 2006; 47(5): 820 - 821. [Full Text] [PDF]
|
|
|
|
|
|
G. Schillaci, M. Pirro, G. Pucci, M. R. Mannarino, F. Gemelli, D. Siepi, G. Vaudo, and E. Mannarino Different Impact of the Metabolic Syndrome on Left Ventricular Structure and Function in Hypertensive Men and Women Hypertension, May 1, 2006; 47(5): 881 - 886. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Norman, J. S. Loredo, R. A. Nelesen, S. Ancoli-Israel, P. J. Mills, M. G. Ziegler, and J. E. Dimsdale Effects of Continuous Positive Airway Pressure Versus Supplemental Oxygen on 24-Hour Ambulatory Blood Pressure Hypertension, May 1, 2006; 47(5): 840 - 845. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. H. Sert Kuniyoshi and V. K. Somers Sleep Apnea in Hypertension: When, How, and Why Should We Treat? Hypertension, May 1, 2006; 47(5): 818 - 819. [Full Text] [PDF]
|
|
|
|
|
|
G. Schillaci, M. Pirro, T. Ronti, F. Gemelli, G. Pucci, S. Innocente, C. Porcellati, and E. Mannarino Prognostic Impact of Prolonged Ventricular Repolarization in Hypertension. Arch Intern Med, April 24, 2006; 166(8): 909 - 913. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. C. Gallo and K. A. Matthews Adolescents' attachment orientation influences ambulatory blood pressure responses to everyday social interactions. Psychosom Med, March 1, 2006; 68(2): 253 - 261. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Kivimaki, D. A. Lawlor, G. D. Smith, L. Keltikangas-Jarvinen, M. Elovainio, J. Vahtera, L. Pulkki-Raback, L. Taittonen, J. S.A. Viikari, and O. T. Raitakari Early Socioeconomic Position and Blood Pressure in Childhood and Adulthood: The Cardiovascular Risk in Young Finns Study Hypertension, January 1, 2006; 47(1): 39 - 44. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Pelliccia, R. Fagard, H. H. Bjornstad, A. Anastassakis, E. Arbustini, D. Assanelli, A. Biffi, M. Borjesson, F. Carre, D. Corrado, et al. Recommendations for competitive sports participation in athletes with cardiovascular disease: A consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology Eur. Heart J., July 2, 2005; 26(14): 1422 - 1445. [Full Text] [PDF]
|
|
|
|
|
|
P. Verdecchia and F. Angeli How Can We Use the Results of Ambulatory Blood Pressure Monitoring in Clinical Practice? Hypertension, July 1, 2005; 46(1): 25 - 26. [Full Text] [PDF]
|
|
|
|
|
|
A. Steptoe, L. Brydon, and S. Kunz-Ebrecht Changes in Financial Strain Over Three Years, Ambulatory Blood Pressure, and Cortisol Responses to Awakening Psychosom Med, March 1, 2005; 67(2): 281 - 287. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Bochud, P. Bovet, R. C. Elston, F. Paccaud, C. Falconnet, M. Maillard, C. Shamlaye, and M. Burnier High Heritability of Ambulatory Blood Pressure in Families of East African Descent Hypertension, March 1, 2005; 45(3): 445 - 450. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Kupper, G. Willemsen, H. Riese, D. Posthuma, D. I. Boomsma, and E. J.C. de Geus Heritability of Daytime Ambulatory Blood Pressure in an Extended Twin Design Hypertension, January 1, 2005; 45(1): 80 - 85. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Perez-Lloret, A. G. Aguirre, D. P. Cardinali, and J. E. Toblli Disruption of Ultradian and Circadian Rhythms of Blood Pressure in Nondipper Hypertensive Patients Hypertension, September 1, 2004; 44(3): 311 - 315. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Palatini, M. Winnicki, M. Santonastaso, L. Mos, D. Longo, V. Zaetta, M. D. Follo, T. Biasion, and A. C. Pessina Prevalence and Clinical Significance of Isolated Ambulatory Hypertension in Young Subjects Screened for Stage 1 Hypertension Hypertension, August 1, 2004; 44(2): 170 - 174. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Yates Adjustment of antihypertensive medication using home based, patient monitored blood pressure reduced both intensity of treatment and blood pressure control Evid. Based Nurs., July 1, 2004; 7(3): 80 - 80. [Full Text] [PDF]
|
|
|
|
|
|
M. Kivimaki, M.-L. Kinnunen, T. Pitkanen, J. Vahtera, M. Elovainio, and L. Pulkkinen Contribution of Early and Adult Factors to Socioeconomic Variation in Blood Pressure: Thirty-Four-Year Follow-up Study of School Children Psychosom Med, March 1, 2004; 66(2): 184 - 189. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Verdecchia, F. Angeli, and R. Gattobigio Clinical Usefulness of Ambulatory Blood Pressure Monitoring J. Am. Soc. Nephrol., January 1, 2004; 15(90010): S30 - 33. [Abstract] [Full Text]
|
|
|
|
|
|
A. V. Chobanian, G. L. Bakris, H. R. Black, W. C. Cushman, L. A. Green, J. L. Izzo Jr, D. W. Jones, B. J. Materson, S. Oparil, J. T. Wright Jr, et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Hypertension, December 1, 2003; 42(6): 1206 - 1252. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Cicconetti, S. Morelli, C. De Serra, V. Ciotti, F. Chiarotti, M. G. de Marle, L. Ottaviani, N. Riolo, and V. Marigliano Left Ventricular Mass in Dippers and Nondippers with Newly Diagnosed Hypertension Angiology, November 1, 2003; 54(6): 661 - 669. [Abstract] [PDF]
|
|
|
|
 |
|
 T. G Pickering How should we take blood pressure in clinical practice?: The wider use of home and ambulatory monitoring should be encouraged BMJ, October 6, 2003; 327(7418): E150 - 151. [Full Text] [PDF]
|
|
|
|
|
|
H. Trang, S. Boureghda, I. Denjoy, M. Alia, and M. Kabaker 24-Hour BP in Children With Congenital Central Hypoventilation Syndrome Chest, October 1, 2003; 124(4): 1393 - 1399. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. de Divitiis, C. Pilla, M. Kattenhorn, A. Donald, M. Zadinello, S. Wallace, A. Redington, and J. Deanfield Ambulatory blood pressure, left ventricular mass, and conduit artery function late after successful repair of coarctation of the aorta J. Am. Coll. Cardiol., June 18, 2003; 41(12): 2259 - 2265. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. V. Chobanian, G. L. Bakris, H. R. Black, W. C. Cushman, L. A. Green, J. L. Izzo Jr, D. W. Jones, B. J. Materson, S. Oparil, J. T. Wright Jr, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report JAMA, May 21, 2003; 289(19): 2560 - 2571. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. O'Brien Ambulatory blood pressure monitoring in the management of hypertension Heart, May 1, 2003; 89(5): 571 - 576. [Full Text] [PDF]
|
|
|
|
|
|
F. Angeli, P. Verdecchia, C. Pellegrino, R. G. Pellegrino, G. Pellegrino, L. Prosciutti, C. Giannoni, S. Cianetti, and M. Bentivoglio Association Between Periodontal Disease and Left Ventricle Mass in Essential Hypertension Hypertension, March 1, 2003; 41(3): 488 - 492. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Schillaci, L. Pasqualini, P. Verdecchia, G. Vaudo, S. Marchesi, C. Porcellati, G. de Simone, and E. Mannarino Prognostic significance of left ventricular diastolic dysfunction in essential hypertension J. Am. Coll. Cardiol., June 19, 2002; 39(12): 2005 - 2011. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Verdecchia, G. Schillaci, C. Borgioni, R. Gattobigio, G. Ambrosio, and C. Porcellati Prevalent influence of systolic over pulse pressure on left ventricular mass in essential hypertension Eur. Heart J., April 2, 2002; 23(8): 658 - 665. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Verdecchia, G. Reboldi, C. Porcellati, G. Schillaci, S. Pede, M. Bentivoglio, F. Angeli, S. Norgiolini, and G. Ambrosio Risk of cardiovascular disease in relation to achieved office and ambulatory blood pressure control in treated hypertensive subjects J. Am. Coll. Cardiol., March 6, 2002; 39(5): 878 - 885. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Verdecchia, J.A. Staessen, W.B. White, Y. Imai, and E.T. O'Brien Properly defining white coat hypertension Eur. Heart J., January 2, 2002; 23(2): 106 - 109. [Full Text] [PDF]
|
|
|
|
|
|
A. Steptoe and M. Marmot The role of psychobiological pathways in socio-economic inequalities in cardiovascular disease risk Eur. Heart J., January 1, 2002; 23(1): 13 - 25. [Full Text] [PDF]
|
|
|
|
|
|
P. Svensson, U. de Faire, P. Sleight, S. Yusuf, and J. Ostergren Comparative Effects of Ramipril on Ambulatory and Office Blood Pressures: A HOPE Substudy Hypertension, December 1, 2001; 38 (6): e28 - e32. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Verdecchia, C. Porcellati, G. Reboldi, R. Gattobigio, C. Borgioni, T. A. Pearson, and G. Ambrosio Left Ventricular Hypertrophy as an Independent Predictor of Acute Cerebrovascular Events in Essential Hypertension Circulation, October 23, 2001; 104(17): 2039 - 2044. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Verdecchia, G. Schillaci, G. Reboldi, S. S. Franklin, and C. Porcellati Different Prognostic Impact of 24-Hour Mean Blood Pressure and Pulse Pressure on Stroke and Coronary Artery Disease in Essential Hypertension Circulation, May 29, 2001; 103(21): 2579 - 2584. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. L. Poulsen, E. Ebbehøj, H. Arildsen, S. T. Knudsen, K. W. Hansen, H. Mølgaard, and C. E. Mogensen Increased QTc Dispersion Is Related to Blunted Circadian Blood Pressure Variation in Normoalbuminuric Type 1 Diabetic Patients Diabetes, April 1, 2001; 50(4): 837 - 842. [Abstract] [Full Text]
|
|
|
|
|
|
G. Schillaci, G. Reboldi, and P. Verdecchia High-Normal Serum Creatinine Concentration Is a Predictor of Cardiovascular Risk in Essential Hypertension Arch Intern Med, March 26, 2001; 161(6): 886 - 891. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Baltatu, B. J. Janssen, G. Bricca, R. Plehm, J. Monti, D. Ganten, and M. Bader Alterations in Blood Pressure and Heart Rate Variability in Transgenic Rats With Low Brain Angiotensinogen Hypertension, February 1, 2001; 37(2): 408 - 413. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. O'BRIEN Blood pressure measurement is changing! Heart, January 1, 2001; 85(1): 3 - 5. [Full Text]
|
|
|
|
|
|
N. M. Kaplan New Issues in the Treatment of Isolated Systolic Hypertension Circulation, September 5, 2000; 102(10): 1079 - 1081. [Full Text] [PDF]
|
|
|
|
|
|
E. O'Brien, A. Coats, P. Owens, J. Petrie, P. L Padfield, W. A Littler, M. de Swiet, and F. Mee Use and interpretation of ambulatory blood pressure monitoring: recommendations of the British Hypertension Society BMJ, April 22, 2000; 320(7242): 1128 - 1134. [Full Text]
|
|