Published online before print March 27, 2006, doi: 10.1161/01.HYP.0000215363.69793.bb
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(Hypertension. 2006;47:846.)
© 2006 American Heart Association, Inc.
Original Articles |
Long-Term Risk of Mortality Associated With Selective and Combined Elevation in Office, Home, and Ambulatory Blood Pressure
From the Clinica Medica (G.M., R.F., M.B., G.G., R.S.), Università Milano-Bicocca, Ospedale San Gerardo; Centro Interuniversitario di Fisiologia Clinica e Ipertensione (G.M., R.F., M.B., G.G., R.S.), and Centro Auxologico Italiano (G.M., G.G.), Milan, Italy.
Correspondence to Giuseppe Mancia, Clinica Medica, Ospedale S. Gerardo dei Tintori, Via Pergolesi 33, 20052, Milan, Italy. E-mail giuseppe.mancia{at}unimib.it
In the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study, office, home, and ambulatory blood pressure (BP) values were measured contemporaneously between 1990 and 1993 in a large population sample (n=2051). Cardiovascular (CV) and non-CV death certificates were collected over the next 148 months, which allowed us to assess the prognostic value of selective and combined elevation in these 3 BPs over a long follow-up. There were 69 CV and 233 all-cause deaths. Compared with subjects with normal office and 24-hour BP, the hazard ratio for CV death showed a progressive increase in those with a selective office BP elevation (white-coat hypertension), a selective 24-hour BP elevation (masked hypertension), and elevation in both office and 24-hour BP. This was the case also when the above conditions were identified by office versus home BP values. Selective elevation in home versus ambulatory BP or vice versa also carried an increased risk. There was indeed a progressive increase in both CV and all-cause mortality risk from subjects in whom office, home, and ambulatory BP were all normal to those in whom 1, 2, or all 3 BPs were elevated, regardless of which BP was considered. The trends remained significant after adjustment for age and gender, as well as, in most instances, after further adjustment for other cardiovascular risk factors. Thus, white-coat hypertension and masked hypertension, both when identified by office and ambulatory or by office and home BPs, are not prognostically innocent. Indeed, each BP elevation (office, home, or ambulatory) carries an increase in risk mortality that adds to that of the other BP elevations.
Key Words: blood pressure monitoring, ambulatory • hypertension, white-coat • cardiovascular diseases
Related Article:
Hypertension 2006 47: 820-821.
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