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| AMBULATORY BLOOD-PRESSURE - AN INDEPENDENT PREDICTOR OF PROGNOSIS IN ESSENTIAL-HYPERTENSION |
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| Author(s): VERDECCHIA P, PORCELLATI C, SCHILLACI G, BORGIONI C, CIUCCI A, BATTISTELLI M, GUERRIERI M, GATTESCHI C, ZAMPI I, SANTUCCI A, SANTUCCI C, REBOLDI G |
| Source: HYPERTENSION Volume: 24 Issue: 6 Pages: 793-801 Published: DEC 1994 |
| Times Cited: 926 References: 52 |
| Abstract: To determine the prognostic significance of ambulatory blood pressure, we prospectively followed for up to 7.5 years (mean, 3.2) 1187 subjects with essential hypertension and 205 healthy normotensive control subjects who had baseline off-therapy 24-hour noninvasive ambulatory blood pressure monitoring. Prevalence of white coat hypertension, defined by an average daytime ambulatory blood pressure lower than 131/86 mmHg in women and 136/87 mmHg in men in clinically hypertensive subjects, was 19.2%. Cardiovascular morbidity, expressed as the number of combined fatal and nonfatal cardiovascular events per 100 patient-years, was 0.47 in the normotensive group, 0.49 in the white coat hypertension group, 1.79 in dippers with ambulatory hypertension, and 4.99 in nondippers with ambulatory hypertension. After adjustment for traditional risk markers for cardiovascular disease, morbidity did not differ between the normotensive and white coat hypertension groups (P=.83). Compared with the white coat hypertension group, cardiovascular morbidity increased in ambulatory hypertension in dippers (relative risk, 3.70; 95% confidence interval, 1.13 to 12.5), with a further increase of morbidity in nondippers (relative risk, 6.26; 95% confidence interval, 1.92 to 20.32). After adjustment for age, sex, diabetes, and echocardiographic left ventricular hypertrophy (relative risk versus subjects with normal left ventricular mass, 1.52; 95% confidence interval, 1.02 to 3.22), cardiovascular morbidity in ambulatory hypertension was higher (P=.0002) in nondippers than in dippers in women (relative risk, 6.79; 95% confidence interval, 2.45 to 18.82) but not in men (P=.91). Our findings suggest that ambulatory blood pressure stratifies cardiovascular risk in essential hypertension independent of clinic blood pressure and other traditional risk markers including echocardiographic left ventricular hypertrophy. Cardiovascular morbidity is low in white coat hypertension and exceedingly high in women with ambulatory hypertension and absent or blunted blood pressure reduction from day to night. |
| Document Type: Article |
| Language: English |
| Reprint Address: VERDECCHIA, P (reprint author), OSPED GEN REG R SILVESTRINI, UNITA ORGAN MALATTIE CARDIOVASC & MED INTERNA, LOCAL SAN SISTO, I-06100 PERUGIA, ITALY |
Addresses:
1. OSPED BEATO G VILLA, CITTA DELLA PIEVE, ITALY
2. OSPED S AGOSTINO, CASTIGLIONE DEL LAGO, ITALY
3. UNIV PERUGIA, IST MED INTERNA & MED VASC, CATTEDRA STAT & BIOMET, PERUGIA, ITALY
4. UNIV PERUGIA, IST MED INTERNA & SCI ENDOCRINE & METAB, PERUGIA, ITALY |
| Publisher: AMER HEART ASSOC, 7272 GREENVILLE AVENUE, DALLAS, TX 75231-4596 |
| Subject Category: Peripheral Vascular Disease |
| IDS Number: PW837 |
| ISSN: 0194-911X |
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