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(Hypertension. 2005;46:e11.)
© 2005 American Heart Association, Inc.

Hypertension Electronic Pages

Superiority of Ambulatory Over Clinic Blood Pressure Measurement

Serviço de Cardiologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil

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

To the Editor:

Dolan et al, in a large prospective cohort study, compared the risk of all-cause mortality and cardiovascular end points associated to the increase of clinic blood pressure measurement (CBPM) and ambulatory blood pressure measurement (ABPM).¹ They concluded that ABPM is superior (particularly at nighttime) to CBP to predict risk, and that every patient with elevated blood pressure should have ABPM. However, these conclusions based on the data presented in this landmark article can be questioned.

The sample analyzed is not representative of the general population. The majority of patients were referred by family doctors, and the proportion of those with clinical suspicion of white-coat hypertension is not known. In this situation, the performance of clinical measurements to predict risk is worse, and the results could be biased.

The main result is a comparison between ABPM and CBPM in terms of risk associated to increases of 10 mm Hg and 5 mm Hg of systolic and diastolic blood pressures, respectively. If ABPM is a method based on multiple measurements, it has a narrower SD. Each 1-mm Hg increment will result in a greater risk, and hence, the results are obvious. This could explain the better performance of the nighttime period during which the variation of blood pressure is less pronounced in most patients. Figure 2 in the article shows that all the parameters had a continuous relationship with cardiovascular risk, and the steeper curves are those from ABPM. This kind of analysis was questioned by Sega et al² . . . [Full Text of this Article]

Eamon Dolan; Alice Stanton; Eoin O’Brien

ADAPT Centre, Beaumont Hospital, Dublin, Ireland

Jan A. Staessen

Hypertension Unit, University of Leuven, Leuven, Belgium