Prognostic value of direct continuous ambulatory blood pressure monitoring in essential hypertension

Khattar, Rajdeep Singh (1999) Prognostic value of direct continuous ambulatory blood pressure monitoring in essential hypertension. University of Southampton, Doctoral Thesis.

Abstract

This study assessed the value of ambulatory versus clinic blood pressure measurement for the prediction of morbid events, and evaluated the long-term prediction of left ventricular mass and carotid artery structure in a sub-group of uncomplicated hypertensive patients.

The study population consisted of 688 patients, 440 males and 248 females, with a baseline age of 51 ± 11 years who had undergone pretreatment 24 hour intra-arterial ambulatory blood pressure monitoring based on elevated clinic blood pressures. These patients were followed-up over a period of 9.2 ± 4.4 years and a total of 157 first events were recorded. Cox's proportional hazards analysis showed that the predictive value of a regression model containing age, gender, race, body mass index, smoking, diabetes mellitus, fasting cholesterol level and previous history of cardiovascular disease, was significantly improved by the addition of any one of the ambulatory systolic or diastolic blood pressure parameters (whether 24 hour mean, daytime mean or night-time mean) or ambulatory pulse pressure. The most predictive models contained the ambulatory systolic blood pressure parameters. In the model containing 24 hour mean ambulatory systolic blood pressure (p=0.001), age (p<0.001), male gender (p<0.001), South Asian origin (p=0.008), diabetes mellitus (p=0.05) and previous cardiovascular disease (p<0.001) were additional independent predictors of events. Whereas, 24 hour ambulatory systolic blood pressure was linearly related to the incidence of both coronary and cerebrovascular events, 24 hour ambulatory diastolic blood pressure exhibited a positive linear relationship with cerebrovascular events, but a curvilinear relationship with coronary events.

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