title: Discrepancies between office and ambulatory blood pressure: clinical implications.
abstract: BACKGROUND
  Recent trials have documented no benefit from small reductions in blood pressure measured in the clinical office. However, ambulatory blood pressure is a better predictor of cardiovascular events than office-based blood pressure. We assessed control of ambulatory blood pressure in treated hypertensive patients at high cardiovascular risk.
  
  
  METHODS
  We selected 4729 patients from the Spanish Ambulatory Blood Pressure Monitoring Registry. Patients were aged >/=55 years and presented with at least one of the following co-morbidities: coronary heart disease, stroke, and diabetes with end-organ damage. An average of 2 measures of blood pressure in the office was used for analyses. Also, 24-hour ambulatory blood pressure was recorded at 20-minute intervals with a SpaceLabs 90207 device.
  
  
  RESULTS
  Patients had a mean age of 69.6 (+/-8.2) years, and 60.8% of them were male. Average time from the diagnosis of hypertension to recruitment into the Registry was 10.9 (+/-8.4) years. Mean blood pressure in the office was 152.3/82.3 mm Hg, and mean 24-hour ambulatory blood pressure was 133.3/72.4 mm Hg. About 60% of patients with an office-pressure of 130-139/85-89 mm Hg, 42.4% with office-pressure of 140-159/90-99 mm Hg, and 23.3% with office-pressure > or =160/100 mm Hg were actually normotensive, according to 24-hour ambulatory blood pressure criteria (<130/80 mm Hg).
  
  
  CONCLUSIONS
  We suggest that the lack of benefit of antihypertensive therapy in some trials may partly be due to some patients having normal pressure at trial baseline. Ambulatory monitoring of blood pressure may allow for a better assessment of trial eligibility.
authors: Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Spain.
authors: José R
authors: JR
authors: Banegas
authors: Franz H
authors: FH
authors: Messerli
authors: Bernard
authors: B
authors: Waeber
authors: Fernando
authors: F
authors: Rodríguez-Artalejo
authors: Alex
authors: A
authors: de la Sierra
authors: Julián
authors: J
authors: Segura
authors: Alex
authors: A
authors: Roca-Cusachs
authors: Pedro
authors: P
authors: Aranda
authors: Luis M
authors: LM
authors: Ruilope
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D009819:Office Visits; D012042:Registries
chemical_list: D000959:Antihypertensive Agents