title: Risk of cardiovascular disease in relation to achieved office and ambulatory blood pressure control in treated hypertensive subjects.
abstract: OBJECTIVE
  We investigated the prognostic impact of 24-h blood pressure control in treated hypertensive subjects.
  
  
  BACKGROUND
  There is growing evidence that ambulatory blood pressure improves risk stratification in untreated subjects with essential hypertension. Surprisingly, little is known on the prognostic value of this procedure in treated subjects.
  
  
  METHODS
  Diagnostic procedures including 24-h noninvasive ambulatory blood pressure monitoring were undertaken in 790 subjects with essential hypertension (mean age 48 years) before therapy and after an average follow-up of 3.7 years (2,891 patient-years).
  
  
  RESULTS
  At the follow-up visit, 26.6% of subjects achieved adequate office blood pressure control (<140/90 mm Hg), and 37.3% of subjects achieved adequate ambulatory blood pressure control (daytime blood pressure <135/85 mm Hg). Months or years after the follow-up visit, 58 patients suffered a first cardiovascular event. Event rate was lower (0.71 events/100 person-years) among the subjects with adequate ambulatory blood pressure control than among those with higher blood pressure levels (1.87 events/100 person-years) (p = 0.0026). Ambulatory blood pressure control predicted a lesser risk for subsequent cardiovascular disease independently of other individual risk factors (RR 0.36; 95% confidence intervals: 0.18 to 0.70; p = 0.003), including age, diabetes and left ventricular hypertrophy. Office blood pressure control was associated with a nonsignificant lesser risk of subsequent events (RR 0.63; 95% confidence intervals: 0.31 to 1.31; p = NS). In-treatment ambulatory blood pressure was more potent than pre-treatment blood pressure for prediction of subsequent cardiovascular disease.
  
  
  CONCLUSIONS
  Ambulatory blood pressure control is superior to office blood pressure control for prediction of individual cardiovascular risk in treated hypertensive subjects.
authors.affiliation: Università di Perugia ed Ospedale R. Silvestrini, Dipartimento di Malattie Cardiovascolari, Italy. verdec@tin.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Verdecchia
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Reboldi
authors.forename: Carlo
authors.initials: C
authors.lastname: Porcellati
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Schillaci
authors.forename: Sergio
authors.initials: S
authors.lastname: Pede
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bentivoglio
authors.forename: Fabio
authors.initials: F
authors.lastname: Angeli
authors.forename: Silvia
authors.initials: S
authors.lastname: Norgiolini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ambrosio
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000503:physiopathology; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D019722:Sphygmomanometers; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents