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The prognostic value of ambulatory blood pressures

D Perloff, M Sokolow, R Cowan

    JAMA
    |May 27, 1983
    PubMed

    Insights

    Ambulatory blood pressure (ABP) measurements, not office blood pressure (OBP), are crucial for predicting cardiovascular events in patients with essential hypertension. Higher predicted ABPs indicate a greater risk, even when OBPs are similar.

    Area of Science:

    • Cardiovascular Medicine
    • Hypertension Research
    • Clinical Epidemiology

    Background:

    • Essential hypertension is a major risk factor for cardiovascular events.
    • Traditional office blood pressure (OBP) measurements may not fully capture a patient's cardiovascular risk.
    • Ambulatory blood pressure (ABP) monitoring offers a more comprehensive assessment of blood pressure variability.

    Purpose of the Study:

    • To investigate the predictive value of ambulatory blood pressure (ABP) compared to office blood pressure (OBP) for cardiovascular outcomes in essential hypertension.
    • To determine if the difference between measured ABP and predicted ABP (based on OBP) influences clinical outcomes.

    Main Methods:

    • Retrospective analysis of 1,076 patients with essential hypertension.
    • Initial evaluation included both ambulatory blood pressure (ABP) and office blood pressure (OBP) measurements.
    • Patients were categorized based on the discrepancy between observed ABP and ABP predicted from OBP using linear regression.
    • Life-table analyses were used to assess cumulative incidence of fatal and nonfatal cardiovascular events over a ten-year period.

    Main Results:

    • A significantly higher cumulative ten-year incidence of both fatal and nonfatal cardiovascular events was observed in patients with higher than predicted ABPs.
    • This increased risk was evident even when office blood pressures (OBPs) were comparable between groups.
    • The difference between observed ABP and predicted ABP emerged as a significant determinant of clinical outcome.

    Conclusions:

    • Ambulatory blood pressure (ABP) is a more critical determinant of cardiovascular risk than office blood pressure (OBP) in patients with essential hypertension.
    • Discrepancies between ABP and OBP, particularly higher-than-predicted ABPs, identify patients at elevated risk for cardiovascular events.
    • ABP monitoring should be considered for improved risk stratification and management of essential hypertension.

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