Document Detail

Prognostic value of ambulatory blood pressure monitoring in refractory hypertension: a prospective study.
MedLine Citation:
PMID:  9461245     Owner:  NLM     Status:  MEDLINE    
The objective of this study was to establish whether ambulatory blood pressure offers a better estimate of cardiovascular risk than does its clinical blood pressure counterpart in refractory hypertension. This prospective study assessed the incidence of cardiovascular events over time during an average follow-up of 49 months (range, 6 to 96). Patients were referred to specialized hypertension clinics (86 essential hypertension patients who had diastolic blood pressure > 100 mm Hg during antihypertensive treatment that included three or more antihypertensive drugs, one being a diuretic). Twenty-four-hour ambulatory blood pressure monitoring (ABPM) was performed at the time of entrance. End-organ damage was monitored yearly, and the incidence of cardiovascular events was recorded. Patients were divided into tertiles of average diastolic blood pressure during activity according to the ABPM, with the lowest tertile <88 mm Hg (LT, n=29), the middle tertile 88 to 97 mm Hg (MT, n=29), and the highest tertile >97 mm Hg (HT, n=28). While significant differences in systolic and diastolic ambulatory blood pressures were observed among groups, no differences were observed at either the beginning or at the time of the last evaluation for office blood pressure. During the last evaluation, a progression in the end-organ damage score was observed for the HT group but not for the two other groups. Twenty-one of the patients had a new cardiovascular event; the incidence of events was significantly lower for the LT group (2.2 per 100 patient-years) than it was for the MT group (9.5 per 100 patient-years) or for the HT group (13.6 per 100 patient-years). The probability of event-free survival was also significantly different when comparing the LT group with the other two groups (LT versus MT log-rank, P<.04; LT versus HT log-rank, P<.006). The HT group was an independent risk factor for the incidence of cardiovascular events (relative risk, 6.20; 95% confidence interval, 1.38 to 28.1, P<.02). Higher values of ambulatory blood pressure result in a worse prognosis in patients with refractory hypertension, supporting the recommendation that ABPM is useful in stratifying the cardiovascular risk in patients with refractory hypertension.
J Redon; C Campos; M L Narciso; J L Rodicio; J M Pascual; L M Ruilope
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Hypertension     Volume:  31     ISSN:  0194-911X     ISO Abbreviation:  Hypertension     Publication Date:  1998 Feb 
Date Detail:
Created Date:  1998-03-04     Completed Date:  1998-03-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  712-8     Citation Subset:  IM    
Hypertension Clinic, Hospital Clínico, University of Valencia, Spain.
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MeSH Terms
Blood Pressure / physiology
Blood Pressure Monitoring, Ambulatory*
Cardiovascular Diseases / epidemiology
Follow-Up Studies
Hypertension / physiopathology*
Middle Aged
Prospective Studies

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