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(Hypertension. 2006;47:820.)
© 2006 American Heart Association, Inc.

Editorial Commentaries

Compared With Whom?

Addressing the Prognostic Value of Ambulatory Blood Pressure Categories

Paolo Verdecchia; Fabio Angeli; Jan A. Staessen

From the Dipartimento Malattie Cardiovascolari (P.V., F.A.), Ospedale R. Silvestrini, Perugia, Italy; and Laboratory of Hypertension (J.A.S.), Department of Cardiovascular Disease, University of Leuven, Campus Gasthuisberg, Leuven, Belgium.

Correspondence to Paolo Verdecchia, Dipartimento Malattie Cardiovascolari, Ospedale R. Silvestrini, Località S. Andrea delle Fratte, 06132 Perugia, Italy. E-mail verdec@tin.it

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 

Two statisticians meet.

How do you do?

How do I do? Compared to whom?

— —Anonymous

In several longitudinal studies in the general population^1–4 and referred cohorts of hypertensive patients,^5,6 ambulatory blood pressure (BP) proved superior to clinic BP for prediction of the risk of major cardiovascular events and mortality. These studies analyzed ambulatory BP as a continuous variable.^1–6 However, for risk stratification and management of patients, clinicians need operational thresholds, which, by definition, are somewhat arbitrary.

Indeed, several clinical categories based on ambulatory BP have been proposed over the last 2 decades well before the evidence of the prognostic superiority of ambulatory over clinic BP as continuous variables became clear. "White-coat" hypertension (WCH), "masked" hypertension, "nondipping," "overdipping," and "early morning rise" BP patterns are examples of clinical categories of which the prognostic value has been investigated in outcome-based studies.

	Compared With Whom?

 
When addressing the prognostic value of a given clinical category, it is crucial that the reference group be clearly defined. Albeit apparently obvious, the conclusion that a given category is a condition of "increased," "unchanged," or "decreased" risk must require a precise and clinically applicable definition of the control group.

For example, the prognostic impact of WCH, broadly defined by the coexistence of elevated clinic BP with a normal ambulatory BP, has been addressed in some outcome-based studies. The majority of these studies⁷ examined cohorts of referred hypertensive subjects and compared the group with WCH either with subjects with higher ambulatory BP (ambulatory or sustained hypertension) or with healthy normotensive . . . [Full Text of this Article]

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Hypertension 2006 47: 846-853. [Abstract] [Full Text] [PDF]