Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension.
BACKGROUND
It is uncertain whether ambulatory blood-pressure measurements recorded for 24 hours in patients with treated hypertension predict cardiovascular events independently of blood-pressure measurements obtained in the physician's office and other cardiovascular risk factors.


METHODS
We assessed the association between base-line ambulatory blood pressures in treated patients and subsequent cardiovascular events among 1963 patients with a median follow-up of 5 years (range, 1 to 66 months).


RESULTS
We documented new cardiovascular events in 157 patients. In a Cox proportional-hazards model with adjustment for age, sex, smoking status, presence or absence of diabetes mellitus, serum cholesterol concentration, body-mass index, use or nonuse of lipid-lowering drugs, and presence or absence of a history of cardiovascular events, as well as blood pressure measured at the physician's office, higher mean values for 24-hour ambulatory systolic and diastolic blood pressure were independent risk factors for new cardiovascular events. The adjusted relative risk of cardiovascular events associated with a 1-SD increment in blood pressure was 1.34 (95 percent confidence interval, 1.11 to 1.62) for 24-hour ambulatory systolic blood pressure, 1.30 (95 percent confidence interval, 1.08 to 1.58) for ambulatory systolic blood pressure during the daytime, and 1.27 (95 percent confidence interval, 1.07 to 1.57) for ambulatory systolic blood pressure during the nighttime. For ambulatory diastolic blood pressure, the corresponding relative risks of cardiovascular events associated with a 1-SD increment were 1.21 (95 percent confidence interval, 1.01 to 1.46), 1.24 (95 percent confidence interval, 1.03 to 1.49), and 1.18 (95 percent confidence interval, 0.98 to 1.40).


CONCLUSIONS
In patients with treated hypertension, a higher ambulatory systolic or diastolic blood pressure predicts cardiovascular events even after adjustment for classic risk factors including office measurements of blood pressure.
Clement
Denis L
DL
Department of Cardiovascular Diseases, Ghent University, Ghent, Belgium. denis.clement@skynet.be
De Buyzere
Marc L
ML
De Bacquer
Dirk A
DA
de Leeuw
Peter W
PW
Duprez
Daniel A
DA
Fagard
Robert H
RH
Gheeraert
Peter J
PJ
Missault
Luc H
LH
Braun
Jacob J
JJ
Six
Roland O
RO
Van Der Niepen
Patricia
P
O'Brien
Eoin
E
D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors
D000959:Antihypertensive Agents