Ambulatory blood pressure as a predictor of

cardiovascular risk: What’s new?

Office, home, and ambulatory blood pressures as predictors of cardiovascular risk

Niiranen TJ et al. Hypertension. 2014;64:281-286.

• Many cross-sectional and follow-up studies have shown that home and ambulatory blood pressure measurements are more strongly associated with hypertensive target-organ damage and cardiovascular prognosis than office blood pressure.

• However, data comparing home versus ambulatory blood pressure in a prognostic setting are extremely scarce because only 2 studies with contradictory results and inadequate end points have been published.

• The main purpose of this study is to elucidate the prognostic significance of office versus home versus ambulatory blood pressure.

• The study included 502 patients from Finland with a follow-up of 16.1±3.9 years.

• The primary end point was the combination of cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, percutaneous coronary intervention, and coronary artery bypass graft surgery. Only the first event was included in the analysis.

Ambulatory blood pressure (BP), especially nighttime BP, is prognostically superior to office and home BP

Office, home, and ambulatory blood pressures as predictors of 16.1-year risk of cardiovascular events. The figure is adjusted for other cardiovascular risk factors.

Niiranen TJ et al. Hypertension. 2014;64:281-286.

Effective decrease in nocturnal systolic blood pressure with amlodipine/perindopril

Dolan E et al; ASCOT Investigators. J Hypertens. 2009;27:876-885.

Better survival among patients treated with amlodipine/perindoprilrelated to better nighttime blood pressure control

1 2 3 4 5 (years)120

125

130

Nighttime SBP

Mean difference = –2.2 mm Hg

Atenolol/thiazide

Amlodipine/Perindopril