Use of ambulatory and home blood pressure (BP) measurements

Size: px
Start display at page:

Download "Use of ambulatory and home blood pressure (BP) measurements"

Transcription

1 Long-Term Risk of Mortality Associated With Selective and Combined Elevation in Office, Home, and Ambulatory Blood Pressure Giuseppe Mancia, Rita Facchetti, Michele Bombelli, Guido Grassi, Roberto Sega Abstract In the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study, office, home, and ambulatory blood pressure (BP) values were measured contemporaneously between 1990 and 1993 in a large population sample (n 2051). Cardiovascular (CV) and non-cv death certificates were collected over the next 148 months, which allowed us to assess the prognostic value of selective and combined elevation in these 3 BPs over a long follow-up. There were 69 CV and 233 all-cause deaths. Compared with subjects with normal office and 24-hour BP, the hazard ratio for CV death showed a progressive increase in those with a selective office BP elevation (white-coat hypertension), a selective 24-hour BP elevation (masked hypertension), and elevation in both office and 24-hour BP. This was the case also when the above conditions were identified by office versus home BP values. Selective elevation in home versus ambulatory BP or vice versa also carried an increased risk. There was indeed a progressive increase in both CV and all-cause mortality risk from subjects in whom office, home, and ambulatory BP were all normal to those in whom 1, 2, or all 3 BPs were elevated, regardless of which BP was considered. The trends remained significant after adjustment for age and gender, as well as, in most instances, after further adjustment for other cardiovascular risk factors. Thus, white-coat hypertension and masked hypertension, both when identified by office and ambulatory or by office and home BPs, are not prognostically innocent. Indeed, each BP elevation (office, home, or ambulatory) carries an increase in risk mortality that adds to that of the other BP elevations. (Hypertension. 2006; 47: ) Key Words: blood pressure monitoring, ambulatory hypertension, white-coat cardiovascular diseases Use of ambulatory and home blood pressure (BP) measurements has allowed us to discover 2 conditions that were unknown when BP was mainly measured in the clinic environment, that is: (1) isolated office (or white-coat) hypertension (HT), in which BPs obtained in the office are 140 mm Hg systolic or 90 mm Hg diastolic, whereas ambulatory or home BP values remain within their normal range; and (2) masked HT, in which office BP is normal, whereas ambulatory or home BPs are elevated. 1 The clinical significance of these conditions is still a matter of debate, because cross-sectional studies aimed at examining whether white-coat HT is accompanied by a greater incidence of HT-related organ damage have not provided univocal results. 2 4 In addition, and more importantly, the results have not been univocal in the few studies that have addressed this issue prospectically and have reported white-coat HT (as diagnosed by office BP elevation and ambulatory BP normality) to carry no increase in the incidence of cerebral or cardiovascular (CV) disease 5 9 or to have a greater or delayed CV risk as compared with that of normotensive subjects Furthermore, masked HT has been reported to have a greater prevalence of organ damage and a prognostically greater risk than that of normotensive individuals and possibly of white-coat hypertensives. 13,17,18 However, the evidence is largely confined to a few studies based on ambulatory BP in populations with selected ages, limited follow-up periods, and variable definitions of ambulatory BP normality over 24 hours or the day only. Finally, limited evidence is available as to the prognostic significance of the 2 above-mentioned clinical conditions, when identified by home BP measurements, that is, procedures of large and growing use in clinical practice. The Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study examined cross-sectionally a large sample representative of the population of Monza (a town in the northeast outskirt of Milan) from 1990 to 1993 to establish the normality range of ambulatory and home BPs. 19 From recruitment to October 2004, contact with participants was maintained by mail and phone, and a copy of the death certificate was obtained for all of the subjects who died. This allowed a number of issues to be examined (some for the first time) in the context of a population and over a long follow-up. First, it allowed the prognostic value of white-coat or masked HT to be assessed over a long observational period Received November 21, 2005; first decision December 21, 2005; revision accepted February 14, From the Clinica Medica (G.M., R.F., M.B., G.G., R.S.), Università Milano-Bicocca, Ospedale San Gerardo; Centro Interuniversitario di Fisiologia Clinica e Ipertensione (G.M., R.F., M.B., G.G., R.S.), and Centro Auxologico Italiano (G.M., G.G.), Milan, Italy. Correspondence to Giuseppe Mancia, Clinica Medica, Ospedale S. Gerardo dei Tintori, Via Pergolesi 33, 20052, Milan, Italy. giuseppe.mancia@ unimib.it 2006 American Heart Association, Inc. Hypertension is available at DOI: /01.HYP bb 846

2 Mancia et al Mortality and Blood Pressure 847 in a general population rather than in selected cohorts of subjects, as in most previous studies. Second, it studied the prognostic value of white-coat or masked HT when the diagnosis is based on home BP vis a vis that based on ambulatory BP. Third, it studied the prognosis of individuals in whom a discrepancy exists between home and ambulatory BP, that is, one is elevated, whereas the other is normal and vice versa. Last, it studied whether and how the elevation of 1, 2, or all 3 BPs has a progressively adverse impact on prognosis, independent of their in-office or out-of-office nature. Methods The methodology used in the PAMELA Study has been reported in detail elsewhere. 19 Briefly, 3200 individuals were randomly selected from the residents of the town of Monza to be representative of the population for gender and age decades (25 to 74 years), according to the criteria used in the World Health Organization-MONItoring trends and determinants on CArdiovascular diseases (MONICA) Study conducted in the same geographic area. The overall participation rate was 64% (n 2051) consistently in each age and sex stratum. The demographic characteristics of nonparticipants were similar to those of participants. This was also the case for CV risk factors based on information collected via phone interviews. Entry Data Participants were invited to come to the outpatient sector of the local hospital (San Gerardo) in the morning of a working day (Monday through Friday), where several data were collected. Those relevant to the present study are (1) 3 sphygmomanometric BP measurements with the subject in the sitting position, starting 10 minutes after the beginning of the medical visit, (2) a 24-hour ambulatory BP monitoring through an oscillometric device (Spacelabs 90207, Spacelabs) with TABLE 1. Baseline Demographic and Clinic Variables According to Office vs 24-Hour or Home BP Office 3 Office 1 Office 3 Office 1 Variable 24-Hour 3 24-Hour 3 24-Hour 1 24-Hour 1 No. of subjects CV deaths, % All-cause deaths, % Male prevalence, % Age, y 45 (12.7) 56.6 (11.9) 49.1 (12.9) 59.3 (10.68) Smokers, % BMI, kg/m (3.7) 27.2 (4.17) 25.9 (3.7) 27.2 (5.1) SBP office, mm Hg (10.3) (14.2) (7.6) (18.3) DBP office, mm Hg 76.8 (6.9) 89.9 (6.8) 82.1 (5.2) 94.2 (9.3) SBP home, mm Hg (13.0) (15.0) (12.2) (17.2) DBP home, mm Hg 71.0 (8.8) 79.1 (8.9) 79.6 (7.0) 85.1 (9.3) SBP 24 hour, mm Hg (6.6) (5.4) (5.7) (10.1) DBP 24 hour, mm Hg 70.2 (4.9) 72.4 (4.6) 80.0 (4.8) 82.5 (6.9) Serum cholesterol, mmol/l 5.5 (1.0) 6.1 (1.0) 5.8 (1.1) 6.1 (1.0) Blood glucose, mmol/l 4.8 (0.7) 5.1 (0.9) 5.3 (1.8) 5.4 (1.5) Office 3 Office 1 Office 3 Office 1 Variable Home 3 Home 3 Home 1 Home 1 No. of subjects CV deaths, % All-cause deaths, % Male prevalence, % Age, y 43.7 (11.9) 51.8 (11.1) 52.8 (13.2) 60.0 (10.1) Smokers, % BMI, kg/m (3.6) 26.5 (4.5) 26.1 (3.6) 27.5 (4.8) SBP office, mm Hg (10.2) (10.9) (8.0) (18.3) DBP office, mm Hg 76.9 (7.0) 90.4 (6.5) 81.0 (5.2) 93.7 (9.5) SBP home, mm Hg (10.2) (7.8) (12.6) (15.3) DBP home, mm Hg 69.8 (6.9) 75.1 (5.2) 84.4 (9.1) 86.0 (9.2) SBP 24 hour, mm Hg (7.5) (7.8) (8.8) (12.4) DBP 24 hour, mm Hg 70.8 (5.5) 75.5 (6.1) 76.0 (6.3) 80.0 (8.2) Serum cholesterol, mmol/l 5.5 (1.0) 5.9 (1.1) 5.9 (1.0) 6.1 (1.0) Blood glucose, mmol/l 4.8 (0.7) 5.2 (1.3) 5.2 (1.6) 5.4 (1.3) Data are shown as mean (SD) or %. SBP indicates systolic BP; DBP, diastolic BP; BMI, body mass index; office 24 hour 1 or office 1 home 3, white-coat HT; office 3 24 hour or office 3 home 1, masked HT.

3 848 Hypertension May 2006 Figure 1. Percentage incidence of CV (f) and all-cause death ( ) over an average follow-up of 148 months in subjects with various combinations of normality or elevation in office, home, and 24-hour BP. Data are adjusted for age and gender. Numbers refer to 2 trends and related P values. the BP readings set at 20-minute intervals (the subjects were sent home after checking for the device accuracy with the instruction to attend at their usual activities and to come back the next morning for the device removal), (3) 2 home BP measurements (approximately at 7:00 AM and 7:00 PM) through a validated semiautomatic device (Model HP 5331, Philips) using the arm contralateral to that used for ambulatory monitoring, (4) 3 additional sphygmomanometric sitting BP measurements, after removal of the ambulatory BP device, and (5) information (history and physical examination) on CV risk factors including overweight, smoking habit, serum cholesterol, blood glucose, diabetes mellitus, and history of previous CV morbid events. Total serum cholesterol and blood glucose levels were measured in all of the subjects by standard radioenzymatic method. Follow-Up From the time of the medical visit to October 1, 2004, a copy of the death certificate was obtained for all of the subjects who died. The causes of death reported in the certificate were coded according to the Tenth International Classification of Diseases. Over an average follow-up period amounting to 148 months, there were 233 deaths, of which 69 were of a CV nature. Data Analysis The 3 office and the 2 home BP measurements obtained at the initial visit were separately averaged. As reported in detail in the article describing the PAMELA data, 19 ambulatory BP values were edited from artifacts according to preselected criteria 20 and averaged for the 24 hours, the day (7:00 AM to 11:00 PM), and the night (11:00 PM to 7:00 AM). Valid ambulatory BP readings were 95.9% of those planned (ie, 72 readings over 24 hours) with an homogeneous distribution (2.9 per hour) throughout the entire recording period and a similar percentage of valid readings compared with the expected ones over the day (95.7%) and the night (96.5%). Based on office (pooled data) and 24-hour ambulatory BP values, subjects were divided into 4 groups: (1) normal office ( 140/90 mm Hg) and 24-hour ( 125/79 mm Hg) systolic and diastolic BP; (2) elevation in office systolic or diastolic BP with normal 24-hour ambulatory BP, that is, isolated office or white-coat HT; (3) normal office BP with elevation in 24-hour home systolic or diastolic BP, that is, masked HT; and (4) elevated office and 24-hour systolic or diastolic BP. A similar subdivision into 4 groups was made based on office versus home BP values normality ( 135 mm Hg systolic or 83 mm Hg diastolic) or elevations ( 135 mm Hg systolic or 83 mm Hg diastolic). Subjects were divided into 4 groups also according to the normal and/or elevated 24-hour and home BP values. The upper normality values of 24-hour and home BPs were derived from the cross-sectional data obtained in the whole PAMELA population based on their correspondence with office BPs equal to 140/ 90 mm Hg on the regression line linking the 3 BPs. 19 These values are superimposable to the normality values reported by other studies using different approaches and mentioned by international guidelines as the most likely cutoffs dividing out-of-office HT from normoten-

4 Mancia et al Mortality and Blood Pressure 849 Figure 2. Hazard ratios (HR, 95% confidence intervals) for CV death in subjects with white-coat HT, masked HT, or elevations in both in-office and out-of-office BP versus subjects with in-office and out-of-office BP normality, as defined in Figure 1. HRs are also shown for subjects with elevation in 1, 2, or all 3 available BPs versus those in whom all 3 BPs were normal (D) regardless of whether the elevation involved office, home, or ambulatory BP., unadjusted data;, data adjusted for age and gender. Symbols and explanations as in the preceding figure. sion. 1,21 The incidence of events was calculated via a logistic model. The hazard ratio was calculated by the Cox proportional hazard model, the assumption of BP proportionality being assessed by proper statistical test. The 2 test was used to evaluate the trends in death incidence or hazard ratio: (1) from the normotensive to white-coat hypertensive, masked hypertensive, and in-office and out-of-office hypertensive group; (2) from the group with normal 24-hour and home BP, the group with selective 24-hour BP elevation, the group with selective home BP elevation, and the group with elevation in both 24-hour and home BP; and (3) from the group with no BP elevation to the groups with elevation in 1, 2, or all 3 of the BPs, regardless of whether they were measured. Groups were ordered in the above fashion because of the suggestion from previous studies that: (1) in white-coat HT, CV damage and risk may be greater than in true normotension but less in true HT 2,3,5,6 13 ; (2) masked HT may be clinically worse than white-coat HT because of the superior prognostic significance of ambulatory versus office BP 14 ; and (3) the ability of home BP to predict the risk of death compares favorably with that of ambulatory BP. 14 Data were adjusted for age and gender. Further adjustments were also made for history of CV disease, smoking prevalence, blood glucose, and serum total cholesterol, which were included as covariates into the model. Throughout the text, values in parentheses refer to the SD of the mean. A 2-tailed P value 0.05 was considered to be statistically significant. Results As shown in Table 1, compared with normotensive subjects, subjects with white-coat HT, masked HT, and elevation, both in-office and out-of-office BP showed a greater male prevalence, age, body mass index, serum total cholesterol, and blood glucose. This was the case either when BP normality and elevation were identified by office versus 24-hour and by office versus home BP criteria (Table 1, bottom). As shown in Figure 1A and 1B, compared with normotensive subjects, age- and gender-adjusted incidence of CV and all-cause death were usually greater in the remaining 3 groups. There was a statistically significant trend toward a progressively greater unadjusted and age- and gender-adjusted risk of CV from the entirely normotensive to the white-coat HT, masked HT, and entirely hypertensive group, regardless of whether BP normality or elevation was identified by office versus ambulatory or by office versus home BP criteria (Figure 2A and 2B). A similar trend was observed for unadjusted hazard ratios for all-cause mortality (Figure 3A and 3B), as well as for further adjustment of the risk of CV mortality and history of CV disease, smoking, serum total cholesterol, and blood glucose (Table 2). Table 3, top, shows the baseline values of 4 groups characterized by 24-hour and home BP normality, selective elevation in 24-hour BP, selective elevation in home BP, and elevation in both 24-hour and home BP. Compared with the first group, male prevalence, age, body mass index, and lipid and glucose variables were invariably greater in the remaining 3 groups. This

5 850 Hypertension May 2006 TABLE 2. Risk of CV or All-Cause Death in Subjects With Various Combinations of Office, Home, and 24-Hour BP Normality or Elevations Cardiovascular Death All-Cause Death Blood Pressure 2 Trend P 2 Trend P Office BP vs home BP Unadjusted After adjustment for age/gender (NS) After further adjustment for serum (NS) cholesterol, blood glucose, and smoking Office BP vs 24-hour BP Unadjusted After adjustment for age/gender (NS) After further adjustment for serum (NS) cholesterol, blood glucose, and smoking Home BP vs 24-hour BP Unadjusted After adjustment for age/gender (NS) After further adjustment for serum (NS) cholesterol, blood glucose, and smoking 0 vs 1, 2, or 3 BP elevations Unadjusted After adjustment for age/gender After further adjustment for serum (NS) cholesterol, blood glucose, and smoking For each BP pair, trend was calculated for normality of both BPs, selective increase in 1 BP, selective increase in the other BP, and increase in both BPs. Trend was also calculated for subjects with no increase in BP or increase in 1, 2, or all 3 BPs. Data were always adjusted for history of CV disease. NS indicates not significant. was associated with a statistically significant trend toward a progressively greater CV and all-cause mortality (Figure 1C). A similar trend was observed for the unadjusted and age- and gender-adjusted hazard ratios for CV, although not for all-cause mortality (Figure 2C, Figure 3C, and Table 2). The trend toward a progressive increase in CV mortality remained significant after further adjustment for history of CV disease, smoking, serum cholesterol, and blood glucose (Table 2). Table 3 (bottom) shows baseline values of subjects in whom office, 24-hour, and home BPs were all normal versus those in whom 1, 2, or all 3 BPs were elevated, regardless of which BP was considered. Male prevalence, age, body mass index, serum total cholesterol, and blood glucose were less in subjects in whom all 3 of the BPs were normal with a progressive increase from the first to the fourth group. This was associated with a statistically significant trend toward a progressively greater ageand gender-adjusted incidence of CV and all-cause mortality (Figure 1D). A similar trend was observed for the unadjusted and age- and gender-adjusted hazard ratios for CV and all-cause mortality (Figures 2D and 3D and Table 2). In both instances, the trend remained significant also after further adjustment for history of CV disease, smoking, serum cholesterol, and blood glucose (Table 2). Discussion Our study allows several conclusions to be made. First, in the PAMELA population, the incidence and risk of CV death showed a progressive increase from subjects in which in-office and out-of-office BPs were both normal to subjects with whitecoat HT, masked HT, and in-office and out-of-office HT, independent of age and gender. Second, the progressive increase in mortality from the entirely normotensive to the entirely hypertensive group occurred regardless of whether the above conditions were identified based on office versus ambulatory or office versus home BP. Thus, white-coat and masked HT are not clinically innocent conditions, but they rather indicate a transition toward a greater risk that reached the maximum when in-office and out-of-office BP are both increased. This has 2 implications for the practice of medicine. First, physicians should not lightly decide to dismiss treatment in patients with white-coat HT. Second, normal office BP values should not be taken as a guarantee that there is no increase in risk because of the possibility of an elevation in out-of-office BP. This implies that out-of-office BP values should be more frequently collected than is recommended by current guidelines. 1 The noticeable prevalence of masked HT in the normotensive fraction of the PAMELA population (14.5% and 15.5% when assessed by ambulatory and office BP, respectively; Reference 14 ) scores in this direction. Our study provides new evidence on other clinically relevant issues. Although in our subjects only 2 home BP measurements were available, a selective elevation in home BP increased the age- and gender-adjusted risk of CV and all-cause mortality to an extent that was, if anything, greater

6 Mancia et al Mortality and Blood Pressure 851 TABLE 3. Baseline Demographic and Clinic Variables According to 24-Hour vs Home BP or to No. of BP Elevations 24-Hour 3 24-Hour 1 24-Hour 3 24-Hour 1 Variable Home 3 Home 3 Home 1 Home 1 No. of subjects CV deaths, % All-cause deaths, % Male prevalence, % Age, y 45.0 (12.2) 48.3 (11.7) 56.7 (12.4) 58.8 (10.8) Smokers, % BMI, kg/m (3.8) 26.0 (4.3) 27.0 (3.9) 27.2 (4.9) SBP office, mm Hg (13.2) (12.5) (16.9) (20.9) DBP office, mm Hg 78.6 (8.4) 87.3 (7.6) 86.2 (8.3) 92.8 (10.4) SBP home, mm Hg (10.5) (6.9) (13.7) (15.4) DBP home, mm Hg 70.1 (6.9) 75.9 (4.4) 84.3 (9.8) 86.3 (8.7) SBP 24 hour, mm Hg (6.6) (5.5) (5.6) (9.9) DBP 24 hour, mm Hg 70.4 (4.9) 80.7 (4.1) 72.6 (4.5) 82.6 (7.2) Serum cholesterol, mmol/l 5.6 (1.0) 6.0 (1.1) 5.9 (1.2) 6.1 (1.1) Blood glucose, mmol/l 4.8 (0.8) 5.1 (1.0) 5.1 (1.5) 5.5 (1.6) Variable N BP 1 0 N BP 1 1 N BP 1 2 N BP 1 3 No. of subjects CV deaths, % All-cause deaths, % Male prevalence, % Age, y 43.7 (11.9) 50.4 (12.7) 55.8 (11.5) 60.0 (10.0) Smokers, % BMI, kg/m (3.6) 25.9 (4.0) 27.2 (4.0) 27.4 (5.2) SBP office, mm Hg (10.1) (12.0) (14.9) (18.2) DBP office, mm Hg 76.4 (6.9) 85.2 (7.2) 88.6 (7.8) 95.0 (9.8) SBP home, mm Hg (10.4) (11.8) (13.3) (15.1) DBP home, mm Hg 69.3 (6.9) 77.4 (8.7) 82.6 (7.8) 86.7 (9.2) SBP 24 hour, mm Hg (6.6) (6.6) (8.01) (10.0) DBP 24 hour, mm Hg 69.9 (4.8) 74.2 (5.2) 76.9 (6.4) 83.0 (7.4) Serum cholesterol, mmol/l 5.5 (1.0) 5.9 (1.1) 6.1 (1.1) 6.1 (1.0) Blood glucose, mmol/l 4.7 (0.7) 5.0 (1.0) 5.3 (1.6) 5.5 (1.4) Data are shown as mean (SD) or %. N BP 1 indicates No. of elevated BPs. SBP, systolic BP; DBP, diastolic BP; BMI, body mass index; office 24 hour 1 or office 1 home 3, white-coat HT; office 3 24 hour or office 3 home 1, masked HT. than the increase associated with a selective elevation in 24-hour BP. This confirms the importance of BP values self-measured in the home environment 9,18 of which the prognostic significance may favorably compare with that of 24-hour BP even when the potential of this approach (daily measurements for weeks) is only partially used. The above, however, does not mean that home BP should be considered just as a substitute of ambulatory BP monitoring, because, in our study, an elevation in only 1 of these out-of-office BPs was accompanied by a risk of CV or all-cause death, which was less than that seen when both of these out-of-office BPs were elevated. Thus, home and ambulatory BP do not represent a duplicate of the same type of information. This is also made clear by the observation that age- and genderadjusted risk of CV and all-cause death increased progressively in subjects in whom office, home, and 24-hour BP were all normal to subjects in whom 1, 2, or all 3 of these BPs were elevated, regardless of which BP showed the elevation. This leads to the conclusion that office, home, and 24-hour BPs have an individual prognostic value that may add to the prognostic value of the others BPs. Thus, obtaining information on office, home, and 24-hour BP may represent the ideal clinical procedure. Confirming previous findings, white-coat hypertensives, masked hypertensives, and hypertensives with in-office and out-of office BP elevations of the PAMELA study all showed body mass index, serum total cholesterol, and blood glucose values that were greater the those of individuals with

7 852 Hypertension May 2006 Figure 3. Unadjusted and age- and gender-adjusted HR for all-cause death in the subjects of Figure 2. Symbols and explanations as in Figure 2. in-office and out-of-office BP normality. In addition, however, they show that body mass index, total serum cholesterol, and plasma glucose all displayed a progressive increase from individuals in whom office, home, and ambulatory BPs were all normal to those in which 1, 2, or all 3 BPs were elevated (Table 1, P for all trends). This emphasizes that there is a close quantitative relationship between metabolic and BP abnormalities, regardless of where and how BP is measured, with each BP offering a specific contribution to the overall dysmetabolic profile. It also makes it obvious that the progressive increase in risk from normotension to white-coat HT, masked HT, and true HT, as well as from subjects with no elevation to subjects with 3 BP elevations may have a multifactorial nature, that is, it may also be because of alterations in glucose and lipid metabolism. BP alterations, per se, however, are likely to be involved, because in all of the above conditions, the progressive increase in CV mortality remained significant after adjustment for differences in metabolic, as well as other risk factors between groups, suggesting that in-office and out-of-office BPs, per se, play a role. This role may be accounted for by the data shown in Tables 1 and 3. That is, in white-coat HT, the office BP elevation was accompanied by ambulatory or home BP values that, although normal, were higher than the values seen in subjects without white-coat HT. Conversely, in masked HT, office BP values, although normal, were higher than those observed in subjects without masked HT. Finally, moving from the condition of no BP elevation to that of 1, 2, or all 3 BP elevations was associated with a progressive increase in all of the BPs, that is, both in the BPs that reached the HT range and in those that remained in the normotensive range (Table 3, bottom). This may have prognostic relevance, because office, home, and 24-hour BP have all been shown to have a continuous relationship with CV risk. 1,2,9,10 Our study has a number of favorable characteristics but also 2 limitations. The favorable characteristics include the long follow-up, as well as the objective nature (death) of the events. One limitation is that the number of CV events was small, given the low CV risk of Mediterranean populations, leading to hazard ratios with large confidence limits. However, the results were often supported by the data on all-cause death, which was 3 times as large as CV death. This was, for example, the case for age- and gender-adjusted risk of all-cause death in subjects with no or 1, 2, or 3 BP elevations. The other limitation is that the observational nature of our study did not allow us to assess the effect on the prognosis of antihypertensive treatment and therapeutic corrections of glucose and lipid abnormalities. Antihypertensive treatment, for example, might have been more common in white-coat than in masked hypertensives, because in the clinical practice treatment is usually guided by office BP elevations, contributing to the better prognosis of the former versus the latter condition.

8 Mancia et al Mortality and Blood Pressure 853 Perspectives Our study provides long-term prognostic evidence that whitecoat or masked HT are not innocent conditions. It also provides evidence that office, home, and 24-hour BP may each have an adverse prognostic value, which adds to that of the other BPs. References 1. Guidelines Committee European Society of Hypertension/ European Society of Cardiology Guidelines for the management of arterial hypertension. J Hypertens. 2003;21: Pickering TG, Coats A, Mallion JM, Mancia G, Verdecchia P. Blood pressure monitoring. Task force V: white-coat hypertension. Blood Press Monit. 1999;4: Mancia G, Zanchetti A. White-coat hypertension: misnomers, misconceptions and misunderstandings. What should we do next? J Hypertens. 1996;14: Verdecchia P, Schillaci G, Boldrini F, Zampi I, Porcellati C. Variability between current definitions of normal ambulatory blood pressure. Implications in the assessment of white coat hypertension. Hypertension. 1992;20: Verdecchia P, Reboldi GP, Angeli F, Schillaci G, Schwartz JE, Pickering TG, Imai Y, Ohkubo T, Kario K. Short-and long-term incidence of stroke in white-coat hypertension. Hypertension. 2005;45: Celis H, Staessen JA, Thijs L, Buntinx F, De Buyzere M, Den Hond E, Fagard RH, O Brien ET for the Ambulatory Blood Pressure and Treatment of Hypertension Trial Investigators. Cardiovascular risk in white-coat and sustained hypertensive patients. Blood Press. 2002;11: Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Porcellati C. Prognostic significance of the white-coat effect. Hypertension. 1997;29: Khattar RS, Swales JD, Banfield A, Dore C, Senior R, Lahiri A. Prediction of coronary and cerebrovascular morbidity and mortality by direct continuous ambulatory blood pressure monitoring in essential hypertension. Circulation. 1999;100: Fagard RH, Van Den Broeke C, De Cort P. Prognostic significance of blood pressure measured in the office, at home and during ambulatory monitoring in older patients in general practice. J Hum Hypertens. 2005; 19: Verdecchia P. Prognostic value of ambulatory blood pressure: current evidence and clinical implications. Hypertension. 2000;35: Strandberg TE, Salomaa V. White coat effects, blood pressure and mortality in men: a prospective cohort study. Eur Heart J. 2000;21: Gustavsen PH, Hoegholm A, Bang LE, Kristensen KS. White-coat hypertension is a cardiovascular risk factor: a 10-year follow-up study. J Hum Hypertens. 2003;17: Ohkubo T, Kikuya M, Metoki H, Asayama K, Obara T, Hashimoto J, Totsune K, Hoshi H, Satoh H, Imai Y. Prognosis of masked hypertension and white-coat hypertension detected by 24-h ambulatory blood pressure monitoring 10-year follow-up from the Ohasama study. JAm Coll Cardiol. 2005;46: Sega R, Trocino G, Lanzarotti A, Carugo S, Cesana G, Schiavina R, Valagussa F, Bombelli M, Giannattasio C, Zanchetti A, Mancia G. Alterations of cardiac structure in patients with isolated office, ambulatory, or home hypertension: data from the general population (Pressioni Arteriose Monitorate E Loro Associazioni [PAMELA] Study). Circulation. 2001; 104: Liu JE, Roman MJ, Pini R, Schwartz JE, Pickering TG, Devereux RB. Cardiac and arterial target organ damage in adults with elevated ambulatory and normal office blood pressure. Ann Intern Med. 1999;131: Lurbe E, Torro I, Alvarez V, Nawrot T, Paya R, Redon J, Staessen JA. Prevalence, persistence, and clinical significance of masked hypertension in youth. Hypertension. 2005;45: Bjorklund K, Lind L, Zethelius B, Andren B, Lithell H. Isolated ambulatory hypertension predicts cardiovascular morbidity in elderly men. Circulation. 2003;107: Bobrie G, Chatellier G, Genes N, Clerson P, Vaur L, Vaisse B, Menard J, Mallion JM. Cardiovascular prognosis of masked hypertension detected by blood pressure self-measurement in elderly treated hypertensive patients. JAMA. 2004;291: Sega R, Cesana G, Milesi C, Grassi G, Zanchetti A, Mancia G. Ambulatory and home blood pressure normality in the elderly data from the PAMELA population. Hypertension. 1997;30: Groppelli A, Omboni S, Parati G, Mancia G. Evaluation of non-invasive blood pressure monitoring devices Spacelabs and versus resting and ambulatory 24 hour intraarterial blood pressure. Hypertension. 1992;20: O Brien E, Asmar R, Beilin L, Imai Y, Mancia G, Mengden T, Myers M, Padfield P, Palatini P, Parati G, Pickering T, Redon J, Staessen J, Stergiou G, Verdecchia P; European Society of Hypertension Working Group on Blood Pressure Monitoring. Practice guidelines of the European Society of Hypertension for clinic, ambulatory and self blood pressure measurement. J Hypertens. 2005;23: Weber MA, Neutel JM, Smith DH, Graettinger WF. Diagnosis of mild hypertension by ambulatory blood pressure monitoring. Circulation. 1994;90: Eastern Stroke and Coronary Heart Disease Collaborative Research Group. Blood pressure, cholesterol and stroke in eastern Asia. Lancet. 1998;532: Lewington S, MacMahon S. Blood pressure, cholesterol and common causes of death: a review. Prospective studies collaboration. Am J Hypertens. 1999;12:96S 98S. 25. Stamler J, Daviglus ML, Garside DB, Dyer AR, Greenland P, Neaton JD. Relationship of baseline serum cholesterol levels in 3 large cohorts of younger men to long-term coronary, cardiovascular and all-cause mortality and longevity. JAMA. 2000;284: Mancia G, Facchetti R, Bombelli M, Friz HP, Grassi G, Giannattasio C, Sega R. Relationship of office, home, and ambulatory blood pressure to blood glucose and lipid variables in the PAMELA population. Hypertension. 2005;45:

White-Coat and Masked Hypertension

White-Coat and Masked Hypertension White-Coat and Masked Hypertension Long-Term Risk of Sustained Hypertension in White-Coat or Masked Hypertension Giuseppe Mancia, Michele Bombelli, Rita Facchetti, Fabiana Madotto, Fosca Quarti-Trevano,

More information

Prognostic significance of blood pressure measured in the office, at home and during ambulatory monitoring in older patients in general practice

Prognostic significance of blood pressure measured in the office, at home and during ambulatory monitoring in older patients in general practice (2005) 19, 801 807 & 2005 Nature Publishing Group All rights reserved 0950-9240/05 $30.00 www.nature.com/jhh ORIGINAL ARTICLE Prognostic significance of blood pressure measured in the office, at home and

More information

Journal of the American College of Cardiology Vol. 46, No. 3, by the American College of Cardiology Foundation ISSN /05/$30.

Journal of the American College of Cardiology Vol. 46, No. 3, by the American College of Cardiology Foundation ISSN /05/$30. Journal of the American College of Cardiology Vol. 46, No. 3, 2005 2005 by the American College of Cardiology Foundation ISSN 0735-1097/05/$30.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2005.03.070

More information

Journal of Hypertension 2004, 22: a Hypertension and Cardiovascular Rehabilitation Unit, Catholic University of

Journal of Hypertension 2004, 22: a Hypertension and Cardiovascular Rehabilitation Unit, Catholic University of Original article 81 Relationship between ambulatory blood pressure and followup clinic blood pressure in elderly patients with systolic hypertension Robert H. Fagard a, Jan A. Staessen a, Lutgarde Thijs

More information

Protocol. Automated Ambulatory Blood Pressure Monitoring for the Diagnosis of Hypertension in Patients with Elevated Office Blood Pressure

Protocol. Automated Ambulatory Blood Pressure Monitoring for the Diagnosis of Hypertension in Patients with Elevated Office Blood Pressure Automated Ambulatory Blood Monitoring for the Diagnosis of Hypertension in Patients with Elevated Office Blood (10102) Medical Benefit Effective Date: 07/01/14 Next Review Date: 03/15 Preauthorization

More information

a Hypertension and Cardiovascular Rehabilitation Unit, Faculty of Medicine, Received 2 June 2008 Revised 1 July 2008 Accepted 9 July 2008

a Hypertension and Cardiovascular Rehabilitation Unit, Faculty of Medicine, Received 2 June 2008 Revised 1 July 2008 Accepted 9 July 2008 Original article 325 Prognostic significance of ambulatory blood pressure in hypertensive patients with history of cardiovascular disease Robert H. Fagard a, Lutgarde Thijs a, Jan A. Staessen a, Denis

More information

Masked Hypertension and Prehypertension: Diagnostic Overlap and Interrelationships With Left Ventricular Mass: The Masked Hypertension Study

Masked Hypertension and Prehypertension: Diagnostic Overlap and Interrelationships With Left Ventricular Mass: The Masked Hypertension Study original contributions nature publishing group Masked Hypertension and Prehypertension: Diagnostic Overlap and Interrelationships With Left Ventricular Mass: The Masked Hypertension Study Daichi Shimbo

More information

Ambulatory Blood Pressure and Prognosis

Ambulatory Blood Pressure and Prognosis Ambulatory Blood Pressure and Prognosis Daytime and Nighttime Blood Pressure as Predictors of Death and Cause-Specific Cardiovascular Events in Hypertension Robert H. Fagard, Hilde Celis, Lutgarde Thijs,

More information

BRIEF COMMUNICATIONS. KEY WORDS: Ambulatory blood pressure monitoring, placebo effect, antihypertensive drug trials.

BRIEF COMMUNICATIONS. KEY WORDS: Ambulatory blood pressure monitoring, placebo effect, antihypertensive drug trials. AJH 1995; 8:311-315 BRIEF COMMUNICATIONS Lack of Placebo Effect on Ambulatory Blood Pressure Giuseppe Mancia, Stefano Omboni, Gianfranco Parati, Antonella Ravogli, Alessandra Villani, and Alberto Zanchetti

More information

Does masked hypertension exist in healthy volunteers and apparently well-controlled hypertensive patients?

Does masked hypertension exist in healthy volunteers and apparently well-controlled hypertensive patients? O R I G I N A L A R T I C L E Does masked hypertension exist in healthy volunteers and apparently well-controlled hypertensive patients? I. Aksoy, J. Deinum, J.W.M. Lenders, Th. Thien *# Department of

More information

Association of Isolated Systolic, Isolated Diastolic, and Systolic-Diastolic Masked Hypertension With Carotid Artery Intima-Media Thickness

Association of Isolated Systolic, Isolated Diastolic, and Systolic-Diastolic Masked Hypertension With Carotid Artery Intima-Media Thickness ORIGINAL PAPER Association of Isolated Systolic, Isolated Diastolic, and Systolic-Diastolic Masked Hypertension With Carotid Artery Intima-Media Thickness Efstathios Manios, MD; 1 Fotios Michas, MD; 1

More information

Clinical Significance and Treatment Requirements in White Coat and Masked Hypertension

Clinical Significance and Treatment Requirements in White Coat and Masked Hypertension Clinical Significance and Treatment Requirements in White Coat and Masked Hypertension 2 Jean-Michel Mallion 2.1 Introduction The phenomena of white coat hypertension (WCHT) and masked hypertension (MH)

More information

White-coat hypertension (WCH), 1 referred to as office 2

White-coat hypertension (WCH), 1 referred to as office 2 Short- and Long-Term Incidence of Stroke in White-Coat Hypertension Paolo Verdecchia, Gian Paolo Reboldi, Fabio Angeli, Giuseppe Schillaci, Joseph E. Schwartz, Thomas G. Pickering, Yutaka Imai, Takayoshi

More information

The natural history of prehypertension. A 20-year follow-up

The natural history of prehypertension. A 20-year follow-up European Review for Medical and Pharmacological Sciences 2017; 21: 1329-1334 The natural history of prehypertension. A 20-year follow-up G. PANNARALE 1, C. MORONI 1, M.C. ACCONCIA 1, G. PANNITTERI 1, G.

More information

Slide notes: References:

Slide notes: References: 1 2 3 Cut-off values for the definition of hypertension are systolic blood pressure (SBP) 135 and/or diastolic blood pressure (DBP) 85 mmhg for home blood pressure monitoring (HBPM) and daytime ambulatory

More information

THE NEW ARMENIAN MEDICAL JOURNAL DISTRIBUTION, AWARENESS, TREATMENT, AND CONTROL OF ARTERIAL HYPERTENSION IN YEREVAN (ARMENIA)

THE NEW ARMENIAN MEDICAL JOURNAL DISTRIBUTION, AWARENESS, TREATMENT, AND CONTROL OF ARTERIAL HYPERTENSION IN YEREVAN (ARMENIA) THE NEW ARMENIAN MEDICAL JOURNAL Vol.5 (2011), Nо 2, p.29-34 DISTRIBUTION, AWARENESS, TREATMENT, AND CONTROL OF ARTERIAL HYPERTENSION IN YEREVAN (ARMENIA) Zelveian P.H. 1, 2, Podosyan G.A. 2 1 Institute

More information

Masked Hypertension: A Review

Masked Hypertension: A Review 479 Review Hypertens Res Vol.30 (2007) No.6 p.479-488 Masked Hypertension: A Review Thomas G. PICKERING 1), Kazuo EGUCHI 1),2), and Kazuomi KARIO 2) Masked hypertension is defined as a normal blood pressure

More information

White coat hypertension, which

White coat hypertension, which H Y P E R T E N S I O N A N D D I A B E T E S D E B A T E S Should White-Coat Hypertension in Diabetes Be Treated? Pro GIUSEPPE MANCIA, MD 1 ROBERTO SEGA, MD 1 MICHELE BOMBELLI, MD 1 White coat hypertension,

More information

ANTIHYPERTENSIVE DRUG THERAPY IN CONSIDERATION OF CIRCADIAN BLOOD PRESSURE VARIATION*

ANTIHYPERTENSIVE DRUG THERAPY IN CONSIDERATION OF CIRCADIAN BLOOD PRESSURE VARIATION* Progress in Clinical Medicine 1 ANTIHYPERTENSIVE DRUG THERAPY IN CONSIDERATION OF CIRCADIAN BLOOD PRESSURE VARIATION* Keishi ABE** Asian Med. J. 44(2): 83 90, 2001 Abstract: J-MUBA was a large-scale clinical

More information

Epidemiology/Population. Prognosis of White-Coat and Masked Hypertension

Epidemiology/Population. Prognosis of White-Coat and Masked Hypertension See Editorial Commentary, pp 670 671 Epidemiology/Population Prognosis of White-Coat and Masked Hypertension International Database of Home Blood Pressure in Relation to Cardiovascular Outcome George S.

More information

Normal Ambulatory Blood Pressure: A Clinical-Practice- Based Analysis of Recent American Heart Association Recommendations

Normal Ambulatory Blood Pressure: A Clinical-Practice- Based Analysis of Recent American Heart Association Recommendations The American Journal of Medicine (2006) 119, 69.e13-69.e18 CLINICAL RESEARCH STUDY Normal Ambulatory Blood Pressure: A Clinical-Practice- Based Analysis of Recent American Heart Association Recommendations

More information

Declaration of conflict of interest

Declaration of conflict of interest Declaration of conflict of interest Prevalence and main features of resistant hypertension in Central and Eastern Europe: data from the G. Brambilla 1, G. Seravalle 2, R. Cifkova 3, C. Farsang 4, S. Laurent

More information

Protocol. Automated Ambulatory Blood Pressure Monitoring for the Diagnosis of Hypertension in Patients With Elevated Office Blood Pressure

Protocol. Automated Ambulatory Blood Pressure Monitoring for the Diagnosis of Hypertension in Patients With Elevated Office Blood Pressure Automated Ambulatory Blood Monitoring for the Diagnosis of Hypertension in Patients With Elevated Office Blood (10102) Medical Benefit Effective Date: 07/01/14 Next Review Date: 03/18 Preauthorization

More information

ORIGINAL INVESTIGATION. Is Isolated Home Hypertension as Opposed to Isolated Office Hypertension a Sign of Greater Cardiovascular Risk?

ORIGINAL INVESTIGATION. Is Isolated Home Hypertension as Opposed to Isolated Office Hypertension a Sign of Greater Cardiovascular Risk? ORIGINAL INVESTIGATION Is Isolated Home as Opposed to Isolated Office a Sign of Greater Cardiovascular Risk? Guillaume Bobrie, MD; Nathalie Genès, MD; Laurent Vaur, MD; Pierre Clerson, MD; Bernard Vaisse,

More information

Home blood pressure measurement is reportedly more

Home blood pressure measurement is reportedly more Day-by-Day Variability of Blood Pressure and Heart Rate at Home as a Novel Predictor of Prognosis The Ohasama Study Masahiro Kikuya, Takayoshi Ohkubo, Hirohito Metoki, Kei Asayama, Azusa Hara, Taku Obara,

More information

The accurate measurement of blood pressure

The accurate measurement of blood pressure Position Paper ASH Position Paper: Home and Ambulatory Blood Pressure Monitoring When and How to Use Self (Home) and Ambulatory Blood Pressure Monitoring Thomas G. Pickering, MD, D Phil; 1 William B. White,

More information

Clinical Implications of Ambulatory and Home Blood Pressure Monitoring

Clinical Implications of Ambulatory and Home Blood Pressure Monitoring REVIEW DOI 10.4070 / kcj.2010.40.9.423 Print ISSN 1738-5520 / On-line ISSN 1738-5555 Copyright 2010 The Korean Society of Cardiology Open Access Clinical Implications of Ambulatory and Home Blood Pressure

More information

Hypertension. Diagnostic Thresholds for Ambulatory Blood Pressure Monitoring Based on 10-Year Cardiovascular Risk

Hypertension. Diagnostic Thresholds for Ambulatory Blood Pressure Monitoring Based on 10-Year Cardiovascular Risk Diagnostic Thresholds for Ambulatory Blood Pressure Monitoring Based on 10-Year Cardiovascular Risk Masahiro Kikuya, MD, PhD; Tine W. Hansen, MD, PhD; Lutgarde Thijs, MSc; Kristina Björklund-Bodegård,

More information

NIH Public Access Author Manuscript J Hum Hypertens. Author manuscript; available in PMC 2011 May 1.

NIH Public Access Author Manuscript J Hum Hypertens. Author manuscript; available in PMC 2011 May 1. NIH Public Access Author Manuscript Published in final edited form as: J Hum Hypertens. 2010 November ; 24(11): 749 754. doi:10.1038/jhh.2010.8. Long-Term Reproducibility of Ambulatory Blood Pressure is

More information

Nocturnal Hypertension or Nondipping: Which Is Better Associated With the Cardiovascular Risk Profile?

Nocturnal Hypertension or Nondipping: Which Is Better Associated With the Cardiovascular Risk Profile? Original Article Nocturnal Hypertension or Nondipping: Which Is Better Associated With the Cardiovascular Risk Profile? Alejandro de la Sierra, 1 Manuel Gorostidi, 2 José R. Banegas, 3 Julián Segura, 4

More information

Journal of Cardiology

Journal of Cardiology Journal of Cardiology 61 (2013) 222 226 Contents lists available at SciVerse ScienceDirect Journal of Cardiology jo u rn al hom epa ge: www.elsevier.com/loca te/jjcc Original article Comparison of demographic,

More information

The initiation of antihypertensive drug treatment relies on

The initiation of antihypertensive drug treatment relies on Ambulatory Blood Pressure Monitoring Strategies for Classifying Patients Based on Office, Home, and Ambulatory Blood Pressure Measurement Lu Zhang, Yan Li, Fang-Fei Wei, Lutgarde Thijs, Yuan-Yuan Kang,

More information

Received 30 May 2008 Revised 11 August 2008 Accepted 21 August 2008

Received 30 May 2008 Revised 11 August 2008 Accepted 21 August 2008 198 Original article Home blood pressure telemonitoring improves hypertension control in general practice. The TeleBPCare study Gianfranco Parati a,b,c, Stefano Omboni d, Fabio Albini a, Lucia Piantoni

More information

Medical Policy An Independent Licensee of the Blue Cross and Blue Shield Association

Medical Policy An Independent Licensee of the Blue Cross and Blue Shield Association Ambulatory Blood Pressure Monitoring Page 1 of 14 Medical Policy An Independent Licensee of the Blue Cross and Blue Shield Association Title: Ambulatory Blood Pressure Monitoring Professional Institutional

More information

Ambulatory blood pressure (ABP) may be normal in

Ambulatory blood pressure (ABP) may be normal in Response to Antihypertensive Therapy in Older Patients With Sustained and Nonsustained Systolic Hypertension Robert H. Fagard, MD; Jan A. Staessen, MD; Lutgarde Thijs, BSc; Jerzy Gasowski, MD; Christopher

More information

ORIGINAL ARTICLE AMBULATORY BLOOD PRESSURE IN OBESITY. Introduction. Patients and Methods

ORIGINAL ARTICLE AMBULATORY BLOOD PRESSURE IN OBESITY. Introduction. Patients and Methods Vol. 2, Issue 1, pages 31-36 ORIGINAL ARTICLE AMBULATORY BLOOD PRESSURE IN OBESITY By Alejandro de la Sierra, MD Luis M. Ruilope, MD Hypertension Units, Hospital Clinico, Barcelona & Hospital 12 de Octubre,

More information

Automated Ambulatory Blood Pressure Monitoring for the Diagnosis of Hypertension in Patients with Elevated Office Blood Pressure

Automated Ambulatory Blood Pressure Monitoring for the Diagnosis of Hypertension in Patients with Elevated Office Blood Pressure Automated Ambulatory Blood Pressure Monitoring for the Diagnosis of Hypertension in Patients with Elevated Office Blood Pressure Policy Number: 1.01.02 Last Review: 9/2014 Origination: 1/1989 Next Review:

More information

Impact of Miscuffing During Home Blood Pressure Measurement on the Prevalence of Masked Hypertension

Impact of Miscuffing During Home Blood Pressure Measurement on the Prevalence of Masked Hypertension Brief Communication Impact of Miscuffing During Home Blood Pressure Measurement on the Prevalence of Masked Hypertension Jean-Jacques Mourad, 1 Marilucy Lopez-Sublet, 1 Sola Aoun-Bahous, 2 Frédéric Villeneuve,

More information

CLINICAL SCIENCE. Angela M. G. Pierin a, Edna C. Ignez a, Wilson Jacob Filho b, Alfonso Júlio Guedes Barbato b, Décio Mion Jr. b

CLINICAL SCIENCE. Angela M. G. Pierin a, Edna C. Ignez a, Wilson Jacob Filho b, Alfonso Júlio Guedes Barbato b, Décio Mion Jr. b CLINICS 2008;63(1):43-50 CLINICAL SCIENCE BLOOD PRESSURE MEASUREMENTS TAKEN BY PATIENTS ARE SIMILAR TO HOME AND AMBULATORY BLOOD PRESSURE MEASUREMENTS Angela M. G. Pierin a, Edna C. Ignez a, Wilson Jacob

More information

Clinical research. Introduction. * Corresponding author. Tel: þ ; fax: þ address:

Clinical research. Introduction. * Corresponding author. Tel: þ ; fax: þ address: European Heart Journal (2005) 26, 2026 2031 doi:10.1093/eurheartj/ehi330 Clinical research Use of 2003 European Society of Hypertension European Society of Cardiology guidelines for predicting stroke using

More information

This article will support the view that white-coat hypertension

This article will support the view that white-coat hypertension CONTROVERSIES IN HYPERTENSION Cardiovascular Risk Associated With White-Coat Hypertension Pro Side of the Argument Giuseppe Mancia, Michele Bombelli, Cesare Cuspidi, Rita Facchetti, Guido Grassi This article

More information

University of Padova, Padua, Italy, and HARVEST Study Group, Italy

University of Padova, Padua, Italy, and HARVEST Study Group, Italy University of Padova, Padua, Italy, and HARVEST Study Group, Italy ISOLATED SYSTOLIC HYPERTENSION IN THE YOUNG DOES NOT IMPLY AN INCREASED RISK OF FUTURE HYPERTENSION NEEDING TREATMENT Mos L, Saladini

More information

Accurate blood pressure (BP) measurement is essential

Accurate blood pressure (BP) measurement is essential AJH 2006; 19:468 474 BP Measurement A Comparison of Home Measurement and Ambulatory Monitoring of Blood Pressure in the Adjustment of Antihypertensive Treatment Teemu J. Niiranen, Ilkka M. Kantola, Risto

More information

The lifetime risk for developing end-stage renal disease is

The lifetime risk for developing end-stage renal disease is Disparate Estimates of Hypertension Control From Ambulatory and Clinic Blood Pressure Measurements in Hypertensive Kidney Disease Velvie Pogue, Mahboob Rahman, Michael Lipkowitz, Robert Toto, Edgar Miller,

More information

Carlos A. Segre, Rubens K. Ueno, Karim R. J. Warde, Tarso A. D. Accorsi, Márcio H. Miname, Chang K. Chi, Angela M. G. Pierin, Décio Mion Júnior

Carlos A. Segre, Rubens K. Ueno, Karim R. J. Warde, Tarso A. D. Accorsi, Márcio H. Miname, Chang K. Chi, Angela M. G. Pierin, Décio Mion Júnior Original Article White-coat Hypertension and Normotension in the League of Hypertension of the Hospital das Clínicas, FMUSP. Prevalence, Clinical and Demographic Characteristics Carlos A. Segre, Rubens

More information

The Working Group on Blood Pressure Monitoring of

The Working Group on Blood Pressure Monitoring of Brief Review Ambulatory Blood Pressure Measurement What Is the International Consensus? The Working Group on Blood Pressure Monitoring of the European Society of Hypertension (ESH) published recommendations

More information

Prospective surveys have established the value of ambulatory

Prospective surveys have established the value of ambulatory Cost-Effectiveness of Ambulatory Blood Pressure A Reanalysis Lawrence R. Krakoff Abstract Accurate diagnosis of hypertension and prognosis for future cardiovascular events can be enhanced through the use

More information

Detection of Masked Hypertension and the Mask Effect in Patients With Well-Controlled Office Blood Pressure

Detection of Masked Hypertension and the Mask Effect in Patients With Well-Controlled Office Blood Pressure Circulation Journal Official Journal of the Japanese Circulation Society http://www.j-circ.or.jp ORIGINAL ARTICLE Hypertension and Circulatory Control Detection of Masked Hypertension and the Mask Effect

More information

Copyright Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Copyright Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Devices and technology 223 Validation of the A&D UA-705 device for self-measurement of blood pressure according to the British Hypertension Society protocol Paolo Verdecchia, Fabio Angeli, Roberto Gattobigio,

More information

Home blood pressure (BP) measurement has been reported

Home blood pressure (BP) measurement has been reported Prognostic Value of the Variability in Home-Measured Blood Pressure and Heart Rate The Finn-Home Study Jouni K. Johansson, Teemu J. Niiranen, Pauli J. Puukka, Antti M. Jula Abstract The objective of the

More information

Validation of the SEJOY BP-1307 upper arm blood pressure monitor for home. blood pressure monitoring according to the European Society of Hypertension

Validation of the SEJOY BP-1307 upper arm blood pressure monitor for home. blood pressure monitoring according to the European Society of Hypertension Validation of the SEJOY BP-1307 upper arm blood pressure monitor for home blood pressure monitoring according to the European Society of Hypertension International Protocol revision 2010 Short title: Validation

More information

From measurement to profiles, phenomena and indices: a workshop of the European Society of Hypertension Eoin O Brien

From measurement to profiles, phenomena and indices: a workshop of the European Society of Hypertension Eoin O Brien Introductory note 291 From measurement to profiles, phenomena and indices: a workshop of the European Society of Hypertension Eoin O Brien Blood Pressure Monitoring 2005, 10:291 295 Blood Pressure Unit

More information

OBJECTIVES BACKGROUND METHODS RESULTS CONCLUSIONS

OBJECTIVES BACKGROUND METHODS RESULTS CONCLUSIONS Journal of the American College of Cardiology Vol. 38, No. 1, 2001 2001 by the American College of Cardiology ISSN 0735-1097/01/$20.00 Published by Elsevier Science Inc. PII S0735-1097(01)01325-0 Silent

More information

IDENTIFYING MASKED UNCONTROLLED HYPERTENSION IN THE. RUNNING HEAD: Factors associated with masked uncontrolled hypertension.

IDENTIFYING MASKED UNCONTROLLED HYPERTENSION IN THE. RUNNING HEAD: Factors associated with masked uncontrolled hypertension. IDENTIFYING MASKED UNCONTROLLED HYPERTENSION IN THE COMMUNITY PHARMACY SETTING RUNNING HEAD: Factors associated with masked uncontrolled hypertension. Authors, on behalf of the MEPAFAR study workgroup:

More information

Prognostic Value of Different Indices of Blood Pressure Variability in Hypertensive Patients

Prognostic Value of Different Indices of Blood Pressure Variability in Hypertensive Patients articles nature publishing group Prognostic Value of Different Indices of Blood Pressure Variability in Hypertensive Patients Sante D. Pierdomenico 1,2, Marta Di Nicola 3, Anna L. Esposito 3, Rocco Di

More information

Received 24 February 2015 Revised 29 April 2015 Accepted 20 May 2015

Received 24 February 2015 Revised 29 April 2015 Accepted 20 May 2015 Original article 1 Clinical practice of ambulatory versus home blood pressure monitoring in hypertensive patients Jorge A. Paolasso, Florencia Crespo, Viviana Arias, Eduardo A. Moreyra, Ariel Volmaro,

More information

Ambulatory blood pressure as a predictor of cardiovascular risk

Ambulatory blood pressure as a predictor of cardiovascular risk Review paper Ambulatory blood pressure as a predictor of cardiovascular risk Ankur Sethi, Rohit R. Arora Department of Cardiology, Rosalind Franklin University, Chicago Medical School, North Chicago, IL,

More information

Hypertension Compendium

Hypertension Compendium Hypertension Compendium Circulation Research Compendium on Hypertension The Epidemiology of Blood Pressure and Its Worldwide Management Genetic and Molecular Aspects of Hypertension Hypertension: Renin

More information

Relationship between Clinic and Ambulatory Blood-Pressure Measurements and Mortality

Relationship between Clinic and Ambulatory Blood-Pressure Measurements and Mortality The new england journal of medicine Original Article Relationship between Clinic and Ambulatory Blood-Pressure Measurements and Mortality J.R. Banegas, L.M. Ruilope, A. de la Sierra, E. Vinyoles, M. Gorostidi,

More information

European Society of Hypertension Practice Guidelines for home blood pressure monitoring

European Society of Hypertension Practice Guidelines for home blood pressure monitoring European Society of Hypertension Practice Guidelines for home blood pressure monitoring G Parati 1, GS Stergiou 2, R Asmar 3, G Bilo 1, P de Leeuw 4, Y Imai 5, K Kario 6, E Lurbe 7, A Manolis 8, T Mengden

More information

Review Paper. ID: 8418

Review Paper.   ID: 8418 Review Paper Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring: Executive Summary A Joint Scientific Statement From the American Heart Association, American Society of Hypertension,

More information

Hypertension is common among patients with chronic

Hypertension is common among patients with chronic Hemodialysis Blood Pressure and Mortality Among Hemodialysis Patients Rajiv Agarwal Abstract Blood pressure measured before and after dialysis does not agree well with those recorded outside the dialysis

More information

RESEARCH ABSTRACT INTRODUCTION

RESEARCH ABSTRACT INTRODUCTION Definition of ambulatory blood targets for diagnosis and treatment of hypertension in relation to clinic blood : prospective cohort study Geoffrey A Head, NHMRC principal research fellow and professor

More information

Home and ambulatory blood pressure monitoring offers

Home and ambulatory blood pressure monitoring offers Monitoring Office, Home, and Ambulatory Blood Pressures as Predictors of Cardiovascular Risk Teemu J. Niiranen, Juhani Mäki, Pauli Puukka, Hannu Karanko, Antti M. Jula Abstract Ambulatory blood pressure

More information

White Coat Hypertension

White Coat Hypertension White Coat Hypertension Giuseppe Mancia Guido Grassi Gianfranco Parati Alberto Zanchetti White Coat Hypertension An Unresolved Diagnostic and Therapeutic Problem Giuseppe Mancia Emeritus Professor University

More information

White coat and masked hypertension

White coat and masked hypertension White coat and masked hypertension Conflict of interest Support from Spacelabs, Microlife. Honoraria from Novartis, Elpen, Boeringer-Ingelheim, CANA, Lilly, MSD, Sanofi, Menarini, Ciezi, Astra-Zeneca.

More information

ARIC Manuscript Proposal # 947. PC Reviewed: 07/01/03 Status: A Priority: 2 SC Reviewed: 07/18/03 Status: A Priority: 2

ARIC Manuscript Proposal # 947. PC Reviewed: 07/01/03 Status: A Priority: 2 SC Reviewed: 07/18/03 Status: A Priority: 2 ARIC Manuscript Proposal # 947 PC Reviewed: 07/01/03 Status: A Priority: 2 SC Reviewed: 07/18/03 Status: A Priority: 2 1.a. Full Title: The Impact of Treatment and Adequate Control of Blood Pressure for

More information

When should blood pressure be lowered? Should treatment be guided by blood pressure values or total cardiovascular risk?

When should blood pressure be lowered? Should treatment be guided by blood pressure values or total cardiovascular risk? OF JOURNAL HYPERTENSION JH R RESEARCH Journal of HYPERTENSION RESEARCH www.hypertens.org/jhr Editorial J Hypertens Res (2016) 2(2):47 51 When should blood pressure be lowered? Should treatment be guided

More information

Clinic blood pressure (BP) is greater than ambulatory or

Clinic blood pressure (BP) is greater than ambulatory or Attenuation of the White-Coat Effect by Antihypertensive Treatment and Regression of Target Organ Damage Gianfranco Parati, Luisa Ulian, Lorena Sampieri, Paolo Palatini, Alessandra Villani, Alessandro

More information

The applicability of home blood pressure measurement in clinical practice: A review of literature

The applicability of home blood pressure measurement in clinical practice: A review of literature REVIEW The applicability of home blood pressure measurement in clinical practice: A review of literature Willem J Verberk Abraham A Kroon Heidi A Jongen-Vancraybex Peter W de Leeuw University Hospital

More information

MEDICAL POLICY SUBJECT: AUTOMATED AMBULATORY BLOOD PRESSURE MONITORING

MEDICAL POLICY SUBJECT: AUTOMATED AMBULATORY BLOOD PRESSURE MONITORING MEDICAL POLICY SUBJECT: AUTOMATED AMBULATORY 02/19/09 PAGE: 1 OF: 5 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product, including

More information

Ambulatory blood pressure monitoring has shown that in

Ambulatory blood pressure monitoring has shown that in Difference Between Clinic and Daytime Blood Pressure Is Not a Measure of the White Coat Effect Gianfranco Parati, Luisa Ulian, Cinzia Santucciu, Stefano Omboni, Giuseppe Mancia Abstract The purpose of

More information

The Centers for Medicare and Medicaid Services

The Centers for Medicare and Medicaid Services AJH 2003; 16:87 91 Editorials When Can the Practicing Physician Suspect White Coat Hypertension? Statement From the Working Group on Blood Pressure Monitoring of the European Society of Hypertension Paolo

More information

NIH Public Access Author Manuscript J Hum Hypertens. Author manuscript; available in PMC 2014 September 01.

NIH Public Access Author Manuscript J Hum Hypertens. Author manuscript; available in PMC 2014 September 01. NIH Public Access Author Manuscript Published in final edited form as: J Hum Hypertens. 2014 September ; 28(9): 521 528. doi:10.1038/jhh.2014.9. UNMASKING MASKED HYPERTENSION: PREVALENCE, CLINICAL IMPLICATIONS,

More information

Several studies have reported that blood pressure (BP)

Several studies have reported that blood pressure (BP) Weather-Related Changes in 24-Hour Blood Pressure Profile Effects of Age and Implications for Hypertension Management Pietro Amedeo Modesti, Marco Morabito, Iacopo Bertolozzi, Luciano Massetti, Gabriele

More information

Ambulatory Blood Pressure and Cardiovascular Events in Chronic Kidney Disease. Rajiv Agarwal, MD

Ambulatory Blood Pressure and Cardiovascular Events in Chronic Kidney Disease. Rajiv Agarwal, MD Ambulatory Blood Pressure and Cardiovascular Events in Chronic Kidney Disease Rajiv Agarwal, MD Summary: Hypertension is an important risk factor for adverse cardiovascular and renal outcomes, particularly

More information

Self Measurement of Blood Pressure for Control of Blood Pressure Levels and Adherence to Treatment

Self Measurement of Blood Pressure for Control of Blood Pressure Levels and Adherence to Treatment Self Measurement of Blood Pressure for Control of Blood Pressure Levels and Adherence to Treatment Weimar Kunz Sebba Barroso Souza, Paulo César Brandão Veiga Jardim, Ludmila Porto Brito, Fabrício Alves

More information

Elevated blood pressure (BP) is common and associated with increased

Elevated blood pressure (BP) is common and associated with increased Comparing the Effects of White Coat and Sustained on Mortality in a UK Primary Care Setting Martin G. Dawes, MBBS, PhD (Lond) 1 Gillian Bartlett, PhD 1 Andrew J. Coats, MBBChir (Camb), MA, DM 2 Edmund

More information

Epidemiology of Masked and White-Coat Hypertension: The Family-Based SKIPOGH Study

Epidemiology of Masked and White-Coat Hypertension: The Family-Based SKIPOGH Study Epidemiology of Masked and White-Coat Hypertension: The Family-Based SKIPOGH Study Heba Alwan 1, Menno Pruijm 2, Belen Ponte 3, Daniel Ackermann 4, Idris Guessous 1,5, Georg Ehret 6, Jan A. Staessen 7,8,

More information

1. Department of Gynecology and Obstetrics, St. Joseph's Hospital Berlin Tempelhof, Germany

1. Department of Gynecology and Obstetrics, St. Joseph's Hospital Berlin Tempelhof, Germany Page 1 of 9 Validation of the TONOPORT VI ambulatory blood pressure monitor, according to the European Society of Hypertension International Protocol revision 2010 Michael Abou-Dakn 1, Cornelius Döhmen

More information

Epidemiology/Population. Home Blood Pressure and Cardiovascular Outcomes in Patients During Antihypertensive Therapy

Epidemiology/Population. Home Blood Pressure and Cardiovascular Outcomes in Patients During Antihypertensive Therapy Epidemiology/Population Home Blood Pressure and Cardiovascular Outcomes in Patients During Antihypertensive Therapy Primary Results of HONEST, a Large-Scale Prospective, Real-World Observational Study

More information

NIH Public Access Author Manuscript Blood Press Monit. Author manuscript; available in PMC 2013 November 25.

NIH Public Access Author Manuscript Blood Press Monit. Author manuscript; available in PMC 2013 November 25. NIH Public Access Author Manuscript Published in final edited form as: Blood Press Monit. 2011 August ; 16(4):. doi:10.1097/mbp.0b013e328346d603. Age and the Difference between Awake Ambulatory Blood Pressure

More information

This article will focus on the role of the following in BP management and their prognostic significance:

This article will focus on the role of the following in BP management and their prognostic significance: CARDIOVASCULAR DISORDERS UNIT NO. 2 HOME BLOOD PRESSURE MONITORING, BLOOD PRESSURE VARIABILITY AND MORNING BLOOD PRESSURE SURGE Dr Rohit Khurana, Dr Lucy Priestner ABSTRACT Hypertension is a common chronic

More information

The increasing awareness of hypertension as a serious

The increasing awareness of hypertension as a serious AJH 2002; 15:787 792 Evaluation of the Performance of a Wrist Blood Pressure Measuring Device With a Position Sensor Compared to Ambulatory 24-Hour Blood Pressure Measurements Sakir Uen, Burkard Weisser,

More information

DOI: /HYPERTENSIONAHA

DOI: /HYPERTENSIONAHA Call to Action on Use and Reimbursement for Home Blood Pressure Monitoring: Executive Summary. A Joint Scientific Statement From the American Heart Association, American Society of Hypertension, and Preventive

More information

Insulin resistance influences 24h heart rate and blood pressure variabilities and cardiovascular autonomic modulation in normotensive healthy adults

Insulin resistance influences 24h heart rate and blood pressure variabilities and cardiovascular autonomic modulation in normotensive healthy adults Insulin resistance influences 24h heart rate and blood pressure variabilities and cardiovascular autonomic modulation in normotensive healthy adults Ochoa JE 1, Correa M 2, Valencia AM 2, Gallo J 2, McEwen

More information

Risk Factors for Heart Disease

Risk Factors for Heart Disease Developmental Perspectives on Health Disparities from Conception Through Adulthood Risk Factors for Heart Disease Philip Greenland, MD Harry W. Dingman Professor Chair, Department of Preventive Medicine

More information

Levels of Office Blood Pressure and Their Operating Characteristics for Detecting Masked Hypertension Based on Ambulatory Blood Pressure Monitoring

Levels of Office Blood Pressure and Their Operating Characteristics for Detecting Masked Hypertension Based on Ambulatory Blood Pressure Monitoring Original Article Levels of Office Blood Pressure and Their Operating Characteristics for Detecting Masked Hypertension Based on Ambulatory Blood Pressure Monitoring Anthony J. Viera, 1,2 Feng-Chang Lin,

More information

Ambulatory Blood Pressure Measurements in the Management of Hypertension: Practical Importance

Ambulatory Blood Pressure Measurements in the Management of Hypertension: Practical Importance Ambulatory Blood Pressure Measurements in the Management 10.5005/jp-journals-10043-0003 of Hypertension: Practical Importance Blood pressure measurement Ambulatory Blood Pressure Measurements in the Management

More information

Despite the growing body of evidence supporting the

Despite the growing body of evidence supporting the Sleep and Ambulatory Blood Pressure Ambulatory Blood Pressure and Cardiovascular Outcome in Relation to Perceived Sleep Deprivation Paolo Verdecchia, Fabio Angeli, Claudia Borgioni, Roberto Gattobigio,

More information

CARDIOVASCULAR RISK FACTORS & TARGET ORGAN DAMAGE IN GREEK HYPERTENSIVES

CARDIOVASCULAR RISK FACTORS & TARGET ORGAN DAMAGE IN GREEK HYPERTENSIVES CARDIOVASCULAR RISK FACTORS & TARGET ORGAN DAMAGE IN GREEK HYPERTENSIVES C. Liakos, 1 G. Vyssoulis, 1 E. Karpanou, 2 S-M. Kyvelou, 1 V. Tzamou, 1 A. Michaelides, 1 A. Triantafyllou, 1 P. Spanos, 1 C. Stefanadis

More information

Ambulatory blood pressure measurement is now indispensable to the good clinical management of hypertension

Ambulatory blood pressure measurement is now indispensable to the good clinical management of hypertension CARDIOVASCULAR JOURNAL OF SOUTH AFRICA Vol 14, No. 3, May/June 2003 113 Editorial Ambulatory blood pressure measurement is now indispensable to the good clinical management of hypertension Ambulatory blood

More information

Validation of the OMRON 705 IT blood pressure measuring device according to the International Protocol of the European Society of Hypertension

Validation of the OMRON 705 IT blood pressure measuring device according to the International Protocol of the European Society of Hypertension Validation of the OMRON 705 IT blood pressure measuring device according to the International Protocol of the European Society of Hypertension M. EL ASSAAD, J. TOPOUCHIAN, G. LABAKI, R. ASMAR L Institut

More information

Use and Interpretation of Home Blood Pressure Monitoring

Use and Interpretation of Home Blood Pressure Monitoring Use and Interpretation of Home Blood Pressure Monitoring BLOOD PRESSURE in year 2015 PARAMETERS TODAY Gianfranco Parati University of Milano-Bicocca & Ospedale S.Luca, IRCCS, Istituto Auxologico Italiano

More information

Ambulatory Versus Home Versus Clinic Blood Pressure The Association With Subclinical Cerebrovascular Diseases: The Ohasama Study

Ambulatory Versus Home Versus Clinic Blood Pressure The Association With Subclinical Cerebrovascular Diseases: The Ohasama Study Versus Versus Clinic Blood Pressure The Association With Subclinical Cerebrovascular Diseases: The Ohasama Study Azusa Hara, Kazushi Tanaka, Takayoshi Ohkubo, Takeo Kondo, Masahiro Kikuya, Hirohito Metoki,

More information

ORIGINAL INVESTIGATION. Prognosis of Isolated Systolic and Isolated Diastolic Hypertension as Assessed by Self-Measurement of Blood Pressure at Home

ORIGINAL INVESTIGATION. Prognosis of Isolated Systolic and Isolated Diastolic Hypertension as Assessed by Self-Measurement of Blood Pressure at Home Prognosis of Isolated Systolic and Isolated Diastolic Hypertension as Assessed by Self-Measurement of Blood Pressure at Home The Ohasama Study ORIGINAL INVESTIGATION Atsushi Hozawa, MD; Takayoshi Ohkubo,

More information

The morning pressor surge is an abrupt increase in blood

The morning pressor surge is an abrupt increase in blood Original Articles Prognostic Significance for Stroke of a Morning Pressor Surge and a Nocturnal Blood Pressure Decline The Ohasama Study Hirohito Metoki, Takayoshi Ohkubo, Masahiro Kikuya, Kei Asayama,

More information

Effects of Age on Arterial Stiffness and Blood Pressure Variables in Patients with Newly Diagnosed Untreated Hypertension

Effects of Age on Arterial Stiffness and Blood Pressure Variables in Patients with Newly Diagnosed Untreated Hypertension Original Article Print ISSN 1738-5520 On-line ISSN 1738-5555 Korean Circulation Journal Effects of Age on Arterial Stiffness and Blood Pressure Variables in Patients with Newly Diagnosed Untreated Hypertension

More information

Todd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM

Todd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM Todd S. Perlstein, MD FIFTH ANNUAL SYMPOSIUM Faculty Disclosure I have no financial interest to disclose No off-label use of medications will be discussed FIFTH ANNUAL SYMPOSIUM Recognize changes between

More information

YOUNG ADULT MEN AND MIDDLEaged

YOUNG ADULT MEN AND MIDDLEaged BRIEF REPORT Favorable Cardiovascular Profile in Young Women and Long-term of Cardiovascular and All-Cause Mortality Martha L. Daviglus, MD, PhD Jeremiah Stamler, MD Amber Pirzada, MD Lijing L. Yan, PhD,

More information