Published online before print April 4, 2005, doi: 10.1161/01.CIR.0000160923.04524.5B
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(Circulation. 2005;111:1777-1783.)
© 2005 American Heart Association, Inc.
Health Services and Outcomes Research |
Prognostic Value of Ambulatory and Home Blood Pressures Compared With Office Blood Pressure in the General Population
Follow-Up Results From the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) Study
From Clinica Medica (R.S., R.F., M.B., G.G., G.M.) and Medicina del Lavoro (R.F., G.C.), Dipartimento di Medicina Clinica, Prevenzione e Biotecnologie Sanitarie, Università Milano-Bicocca, Ospedale San Gerardo, Monza; Dipartimento di Statistica (G.C.), Università Milano-Bicocca, Centro Interuniversitario di Fisiologia Clinica e Ipertensione (G.G., G.M.), IRCCS Ospedale Maggiore; and IRCCS Istituto Auxologico Italiano (G.G., G.M.), Milano, Italy.
Correspondence to Professor Giuseppe Mancia, MD, Clinica Medica, Ospedale S. Gerardo dei Tintori, Via Donizetti 106, 20052 Monza, Milan, Italy. E-mail giuseppe.mancia{at}unimib.it
Received July 21, 2004; revision received December 22, 2004; accepted December 27, 2004.
Background— Studies in hypertensive patients suggest that ambulatory blood pressure (BP) is prognostically superior to office BP. Much less information is available in the general population, however. Obtaining this information was the purpose of the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study.
Methods and Results— Office, home, and 24-hour ambulatory BP values were obtained in 2051 subjects between 25 and 74 years of age who were representative of the general population of Monza (Milan, Italy). Subjects were followed up for an average of 131 months, during which time cardiovascular and noncardiovascular fatal events were recorded (n=186). Office, home, and ambulatory BP values showed a significant exponential direct relationship with risk of cardiovascular or all-cause death. The goodness of fit of the relationship was greater for systolic than for diastolic BP and for night than for day BP, but its overall value was not better for home or ambulatory than for office BP. The slope of the relationship, however, was progressively greater from office to home and ambulatory BP. Home and night BP modestly improved the goodness of fit of the risk model when added to office BP.
Conclusions— In the PAMELA population, risk of death increased more with a given increase in home or ambulatory than in office BP. The overall ability to predict death, however, was not greater for home and ambulatory than for office BP, although it was somewhat increased by the combination of office and outside-of-office values. Systolic BP was almost invariably superior to diastolic BP, and night BP was superior to day BP.
Key Words: blood pressure monitoring • heart rate • mortality
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Circulation 2005 111: 1729.
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