Discrepancies between office and ambulatory blood pressure: clinical implications

Area of Science:

• Cardiology
• Hypertension Research
• Clinical Trials

Background:

• Office blood pressure measurements show limited benefit in recent trials.
• Ambulatory blood pressure is a superior predictor of cardiovascular events compared to office readings.
• This study focuses on ambulatory blood pressure control in treated hypertensive patients at high cardiovascular risk.

Purpose of the Study:

• To assess the control of ambulatory blood pressure in treated hypertensive patients at high cardiovascular risk.
• To investigate discrepancies between office and ambulatory blood pressure measurements.
• To evaluate the impact of ambulatory blood pressure monitoring on clinical trial eligibility.

Main Methods:

• Analysis of 4729 patients from the Spanish Ambulatory Blood Pressure Monitoring Registry.
• Inclusion criteria: age >=55 years with coronary heart disease, stroke, or diabetes with end-organ damage.
• Comparison of office blood pressure (average of 2 measures) with 24-hour ambulatory blood pressure (recorded every 20 minutes).

Main Results:

• Mean patient age was 69.6 years, with 60.8% males.
• Mean office blood pressure was 152.3/82.3 mm Hg; mean 24-hour ambulatory blood pressure was 133.3/72.4 mm Hg.
• Significant proportions of patients with elevated office readings (e.g., 60% with 130-139/85-89 mm Hg) were normotensive by ambulatory criteria (<130/80 mm Hg).

Conclusions:

• Normal baseline ambulatory blood pressure in some patients may explain the lack of benefit observed in certain antihypertensive therapy trials.
• Ambulatory blood pressure monitoring offers a more accurate assessment of blood pressure control.
• Ambulatory monitoring can improve the selection of eligible participants for clinical trials.