title: The association between ambulatory systolic blood pressure and cardiovascular events in a selected population with intensive control of cardiovascular risk factors.
abstract: Recent guidelines recommend a target clinic systolic blood pressure (BP) of <140 mm Hg. These recommendations are based on the relationship of office BP measurements and cardiovascular (CV) events. We evaluated the association between 24-hour ambulatory BP measurements (24H ABPM) and CV events in a selected population with intensive control of CV risk factors. We retrospectively followed all patients who had undergone 24H ABPM during 2005 at the Institute of Periodic Medical Examinations, Chaim Sheba Medical Center, Tel-Hashomer, Israel, to monitor the development of CV events. These patients were followed closely and treated meticulously in order to control CV risk factors. The study population consisted of 317 patients (81% males; mean age, 59.2 ± 9.8 years) followed for a mean period of 6.4 ± 2.1 years (median, 6 years). During follow-up, 22 patients had their first CV event. Patients who experienced CV events were significantly older, more likely diabetic, and had a history of previous CV disease. Twenty-four-hour ABPM systolic BP ≥140 mm Hg was not associated with increased CV events, whereas 24H ABPM systolic BP ≥150 mm Hg was. Logistic regression analysis showed that 24H ABPM systolic BP ≥150 mm Hg, a former smoker, old age, and a history of CV disease were associated with CV events during follow-up. We found that, in a population aggressively managed for CV risk factors, 24H ABPM systolic BP ≥150 mm Hg is associated with increased CV events.
authors.affiliation: Department of Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Wasseem
authors.initials: W
authors.lastname: Rock
authors.affiliation: Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Moshe
authors.initials: M
authors.lastname: Leshno
authors.affiliation: Department of Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Gadi
authors.initials: G
authors.lastname: Shlomai
authors.affiliation: Department of Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Avshalom
authors.initials: A
authors.lastname: Leibowitz
authors.affiliation: Department of Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: Yehonatan
authors.initials: Y
authors.lastname: Sharabi
authors.affiliation: Department of Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: grosse@post.tau.ac.il.
authors.forename: Ehud
authors.initials: E
authors.lastname: Grossman
mesh_terms: D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000503:physiopathology; D002940:Circadian Rhythm; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: Ambulatory systolic blood pressure; cardiovascular events