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Reproducibility and Treatment Effect on Office and Ambulatory Pressure Relation
Giuseppe Mancia1, Rita Facchetti1,2, Fosca Quarti-Trevano3,2
1University Milano-Bicocca, Milan, Italy (G.M., R.F., G.G.).
Insights
Guidelines for hypertension use 24-hour blood pressure (BP) values based on office BP. This study found these values differ between treated and untreated patients, suggesting separate estimations for accuracy.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Trials
Background:
- Current hypertension guidelines rely on 24-hour ambulatory blood pressure (BP) values derived from office BP measurements in the absence of outcome-based trials.
- It remains unclear if these corresponding ambulatory BP values are consistent between untreated and treated hypertensive individuals and reproducible over time during treatment.
Purpose of the Study:
- To investigate the relationship between office and 24-hour BP in untreated and treated hypertensive patients.
- To compare the BP values derived from this relationship with those provided in current hypertension guidelines.
Main Methods:
- Utilized data from 2397 patients in the ELSA and PHYLLIS trials.
- Calculated the linear regression relationship between office systolic BP and 24-hour BP at baseline and annually over 3 years of treatment.
- Determined 24-hour BP values corresponding to guideline-defined office BP thresholds.
Main Results:
- A significant linear relationship existed between office and 24-hour BP (systolic and diastolic), though correlation coefficients were modest (r ≤ 0.44).
- The slope of this relationship was reproducible annually during treatment but significantly less steep than in untreated individuals.
- Guideline-derived 24-hour BP values showed notable quantitative and qualitative differences compared to calculated values, particularly in high hypertension and low treatment target ranges.
Conclusions:
- The linear regression slope between office and 24-hour BP is reproducible over time in treated hypertensive patients.
- Steeper slopes in untreated individuals indicate that separate estimations of ambulatory BP values are necessary for improved accuracy in both untreated and treated hypertensive populations.
Background:
In the absence of outcome-based ambulatory blood pressure (BP) trails hypertension guidelines provide 24-hour mean BP values corresponding to trial-validated office BP values. Data are shown for untreated and treated patients together, but whether corresponding ambulatory values are similar in untreated and treated hypertensives and reproducible at yearly measurements during treatment is undefined.
Methods:
In 2397 patients of the ELSA (European Lacidipine Study on Atherosclerosis) and PHYLLIS (Plaque Hypertension Lipid-Lowering Italian Study) trials, we calculated the office and 24-hour BP relationship according to the linear regression model, with office systolic BP as the independent variable, at baseline and yearly during a 3-year treatment. Twenty-four hour BP values corresponding to clinically important office BP values (hypertension grading and treatment thresholds and targets) were calculated and compared with those provided by guidelines.
Results:
Office and 24-hour systolic BP or diastolic BP always exhibited a significant linear relationship, with, however, limited Pearson correlation coefficients (never >0.44).The slopes of the relationship were superimposable between different years of treatment but always significantly less steep than the slope seen in untreated individuals. Compared with the guideline-provided corresponding values, 24-hour BP showed qualitative and quantitative differences; for example, it was considerably lower and higher than the guideline-corresponding values when office BP was in the high hypertension and low treatment target ranges, respectively.
Conclusions:
In treated patients with hypertension the slope of the office and 24-hour BP linear regression is reproducible over time. However, the slopes are steeper in untreated individuals, indicating that information on ambulatory BP values corresponding to office BP values can be more accurate if separately estimated in these 2 conditions.
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