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Defining blood pressure goals: is it enough to manage total cardiovascular risk?

Giuseppe Mancia1

  • 1Clinica Medica and Dipartimento di Medicina Clinica e Prevenzione, Università, Milano-Bicocca, Ospedale San Gerardo, Monza, Milan, Italy. giuseppe.mancia@unimib.it

Journal of Hypertension. Supplement : Official Journal of the International Society of Hypertension
|July 10, 2009
PubMed

Insights

Lowering blood pressure (BP) is key for cardiovascular protection. However, out-of-office BP monitoring, including home and ambulatory measurements, offers crucial prognostic value for managing hypertension and total cardiovascular risk.

Area of Science:

  • Cardiology
  • Hypertension Management
  • Preventive Medicine

Background:

  • Lowering blood pressure (BP) in hypertensive patients is linked to cardiovascular protection.
  • Established hypertension guidelines set BP goals (e.g., <140/90 mmHg).
  • Controlling office BP alone may not fully manage cardiovascular risk.

Purpose of the Study:

  • To investigate the prognostic value of out-of-office BP measurements.
  • To explore the association between different BP measurements and cardiovascular outcomes.
  • To highlight the importance of comprehensive BP monitoring in managing cardiovascular risk.

Main Methods:

  • Observational study design (Pressioni Arteriose Monitorate E Loro Associazioni).
  • Analysis of office, home, and ambulatory BP measurements.
  • Longitudinal assessment of cardiovascular death risk over 11 years.

Main Results:

  • Cardiovascular death risk increased progressively with higher office, home, and ambulatory BP levels.
  • Smooth 24-hour BP control is crucial, with early morning surge, nighttime BP, and BP variability indicating significant risk.
  • Multiple antihypertensive agents may be necessary for optimal BP control.

Conclusions:

  • Out-of-office BP measurements provide significant prognostic information beyond office BP.
  • Comprehensive 24-hour BP monitoring is essential for accurate cardiovascular risk assessment.
  • Effective hypertension management requires considering factors like BP variability and potentially multiple medications.

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