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Long-term evolution of ambulatory blood pressure and cardiovascular events in hypertensive patients

Philippe Gosse1, Julien Doublet2, Julie Gaudissard2

  • 1Hypertension excellence center, Hôpital Saint-André, University Hospital, Bordeaux, France. philippe.gosse@chu-bordeaux.fr.

Journal of Human Hypertension
|May 1, 2021
PubMed

Insights

The initial ambulatory blood pressure monitoring (ABPM) in hypertensive patients is a strong predictor of cardiovascular events. Even with treatment, persistent high blood pressure readings indicate ongoing cardiovascular risk.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Preventive Medicine

Background:

  • Ambulatory blood pressure monitoring (ABPM) is the gold standard for blood pressure (BP) assessment.
  • ABPM effectively predicts cardiovascular risk.
  • Long-term changes in ABPM and their association with cardiovascular events remain understudied.

Purpose of the Study:

  • To investigate the association between long-term changes in ABPM and the incidence of cardiovascular events.
  • To evaluate the prognostic value of initial versus subsequent ABPM readings in hypertensive patients.

Main Methods:

  • Inclusion of 591 hypertensive patients from the Bordeaux cohort with at least two ABPM recordings.
  • Analysis of cardiovascular events over a 10-year average follow-up period.
  • Categorization of patients into four groups based on baseline and last 24-hour systolic blood pressure (SBP) levels relative to 130 mmHg.

Main Results:

  • Baseline ABPM was a better predictor of future cardiovascular events than the last recorded ABPM.
  • Patients with consistently high SBP (G3) or initially high SBP that normalized (G1) had a worse prognosis than those with consistently controlled SBP (G0).
  • Group G2 (initially controlled SBP that increased) showed similar survival to G0, while G1 indicated some treatment benefit with intermediate risk.

Conclusions:

  • The initial ABPM reading in hypertensive patients holds significant prognostic value for cardiovascular events.
  • Persistent elevated 24-hour BP, even with antihypertensive treatment, is associated with continued cardiovascular risk.
  • Long-term monitoring and risk stratification based on ABPM trends are crucial in managing hypertensive patients.

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