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Average daily blood pressure, not office blood pressure, determines cardiac function in patients with hypertension

W B White1, P Schulman, E J McCabe

  • 1Section of Hypertension, University of Connecticut School of Medicine, Farmington 06032.

JAMA
|February 10, 1989
PubMed

Insights

Office hypertension, or elevated blood pressure only at the doctor's office, does not appear to cause cardiac disease. Ambulatory blood pressure monitoring is key to predicting cardiac damage in hypertensive patients.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Diagnostic Medicine

Background:

  • Hypertension is a significant risk factor for cardiac disease.
  • Discrepancies between office and out-of-office blood pressure readings can complicate diagnosis.
  • Assessing cardiac status in patients with isolated office hypertension requires further investigation.

Purpose of the Study:

  • To investigate the presence of cardiac disease in hypertensive patients with differing blood pressure measurements.
  • To compare cardiac structure and function in patients with office hypertension versus daytime hypertension and normotensive individuals.
  • To determine the predictive value of different blood pressure measurement methods for cardiac end-organ damage.

Main Methods:

  • Prospective study of three age-matched patient groups: office hypertensives, normotensives, and daytime hypertensives.
  • Classification based on casual (office) and awake ambulatory blood pressure readings.
  • Assessment of cardiac parameters including left atrial index, left ventricular mass index, left ventricular filling rate, and ejection fraction.

Main Results:

  • Patients with office hypertension showed significantly lower left atrial and left ventricular mass indices compared to daytime hypertensives.
  • Cardiac function (filling rate, ejection fraction) in office hypertensives was similar to normotensives and superior to daytime hypertensives.
  • No significant difference in cardiac size and function was observed between office hypertensives and normotensive subjects.

Conclusions:

  • Blood pressure elevation solely in the physician's office is associated with cardiac size and function comparable to normotensive individuals.
  • Ambulatory blood pressure monitoring, reflecting average daily blood pressure, is a more reliable predictor of cardiac end-organ damage than office readings alone.
  • Accurate hypertension diagnosis and risk stratification should incorporate out-of-office blood pressure measurements.

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