title: Prognostic value of ambulatory and home blood pressures compared with office blood pressure in the general population: follow-up results from the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study.
abstract: BACKGROUND
  Studies in hypertensive patients suggest that ambulatory blood pressure (BP) is prognostically superior to office BP. Much less information is available in the general population, however. Obtaining this information was the purpose of the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study.
  
  
  RESULTS
  Office, home, and 24-hour ambulatory BP values were obtained in 2051 subjects between 25 and 74 years of age who were representative of the general population of Monza (Milan, Italy). Subjects were followed up for an average of 131 months, during which time cardiovascular and noncardiovascular fatal events were recorded (n=186). Office, home, and ambulatory BP values showed a significant exponential direct relationship with risk of cardiovascular or all-cause death. The goodness of fit of the relationship was greater for systolic than for diastolic BP and for night than for day BP, but its overall value was not better for home or ambulatory than for office BP. The slope of the relationship, however, was progressively greater from office to home and ambulatory BP. Home and night BP modestly improved the goodness of fit of the risk model when added to office BP.
  
  
  CONCLUSIONS
  In the PAMELA population, risk of death increased more with a given increase in home or ambulatory than in office BP. The overall ability to predict death, however, was not greater for home and ambulatory than for office BP, although it was somewhat increased by the combination of office and outside-of-office values. Systolic BP was almost invariably superior to diastolic BP, and night BP was superior to day BP.
authors.affiliation: Clinica Medica, Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università Milano-Bicocca, Ospedale San Gerardo, Monza, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Sega
authors.forename: Rita
authors.initials: R
authors.lastname: Facchetti
authors.forename: Michele
authors.initials: M
authors.lastname: Bombelli
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Cesana
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corrao
authors.forename: Guido
authors.initials: G
authors.lastname: Grassi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
mesh_terms: D000328:Adult; D000368:Aged; D001795:Blood Pressure Determination / Q000379:methods / Q000401:mortality; D018660:Blood Pressure Monitoring, Ambulatory / Q000401:mortality; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012648:Self Care; D016019:Survival Analysis