|
Clinical Question:
Are ambulatory blood pressure monitoring results more predictive than
in-office measurements of cardiovascular events?
Bottom Line:
Conventional BP measurements (in-office) may not identify some individuals
at high or low risk, but these people may be identifiable by the use of
ambulatory BP.
Reference:
Ohkubo T, Kikuya M, Metoki H, et al. Prognosis of "masked" hypertension and
"white-coat" hypertension detected by 24-h ambulatory blood pressure
monitoring 10-year follow-up
from the Ohasama study. J Am Coll Cardiol 2005;46:508-15.
Study Design:
Diagnostic test evaluation
Funding:
Foundation
Setting:
Population-based
Synopsis:
We sought to investigate the prognosis in subjects with "white-coat"
hypertension (WCHT) and "masked" hypertension (MHT), in which blood pressure
(BP) is lower in clinical measurements than during ambulatory monitoring.
The prognostic significance of WCHT remains controversial, and little is
known about MHT. We obtained 24-h ambulatory BP and "casual" BP (i.e.,
obtained in clinical scenarios) values from 1,332 subjects (872 women, 460
men) > or =40 years old in a representative sample of the general population
of a Japanese community. Survival and stroke morbidity were then followed up
for a mean duration of 10 years. Composite risk of cardiovascular mortality
and stroke morbidity examined using a Cox proportional hazards regression
model for subjects with WCHT (casual BP > or =140/90 mm Hg, daytime BP
<135/85> or =135/85 mm Hg; RH 2.13; 95% CI 1.38 to 3.29) or sustained
hypertension (casual BP > or =140/90 mm Hg, daytime BP > or =135/85 mm Hg;
RH 2.26; 95% CI 1.49 to 3.41) than for subjects with sustained normal BP.
Similar findings were observed for cardiovascular mortality and stroke
morbidity among subgroups by gender, use of antihypertensive medication, and
risk factor level (all p for heterogeneity >0.2). |