Diagnosis of hypertension using home or ambulatory blood pressure monitoring: comparison with the conventional strategy based on repeated clinic blood pressure measurements

AJH–APRIL 2000 –VOL. 13, NO. 4, PART 2

POSTERS: Blood Pressure Measurement (including ABPM)

than in night-time, in both male and female essential hypertensive patients. Key Words: Siesta, nocturnal all, abpm, ageing C004 ASSOCIATION OF AMBULATORY PULSE PRESSURE AND HEMODYNAMIC FACTORS WITH HYPERTENSIVE LEFT VENTRICULAR HYPERTROPHY V. Rizzo, F. Di Maio, S. Villatico Campbell, 1D. Tallarico, 1R. Perilli and F. Petretto. Institute of I Clinica Medica, 1VI Clinica Medica, “La Sapienza” University of Rome, Italy To determine the relationship between clinic and ambulatory blood pressures with left ventricular mass and function, 44 patients with mild-to moderate essential hypertension (W.H.O. guidelines) were submitted to 24 H ambulatory blood pressure monitoring (ABPM) and to an echocardiographic evaluation of left ventricular function and mass (LVMI, Penn Convention). Casual blood pressure, morphologic (body mass index, body surface area) and clinic measurements were obtained in all subjects. Echocardiographic evaluation permitted to calculate end systolic stress, peak systolic stress, E/A ratio, ejection fraction, fraction of shortening, pressure half time, deceleration time (diastolic function). Exclusion criteria were ischemic heart disease, secondary hypertension, renal diseases, valvular diseases. The mean ambulatory pulse pressure (MAPP) and mean systolic blood pressure were found linked to LVMI (r⫽0.47, p⬍0.05 and r⫽0.48, p⬍0.01). No significant correlation between common indexes of left ventricular function and MAPP were observed, but body mass index was found as an independent predictor of LVMI. These findings suggest that ABPM can play a role in selecting patients with potential high organ damage. Key Words: Ambulatory pulse pressure; left ventricular mass. C005 DIAGNOSIS OF HYPERTENSION USING HOME OR AMBULATORY BLOOD PRESSURE MONITORING: COMPARISON WITH THE CONVENTIONAL STRATEGY BASED ON REPEATED CLINIC BLOOD PRESSURE MEASUREMENTS G.S. Stergiou*, I.I. Skeva, N.M. Baibas, C.B. Kalkana, L.G. Roussias, T.D. Mountokalakis. Hypertension Center, Third University Department of Medicine, Sotiria Hospital, Athens, Greece The objective of the study was to investigate whether measurement of blood pressure at home (HBP) or by ambulatory monitoring (ABP) are reliable alternatives to the traditional strategy for hypertension diagnosis based on blood pressure measurement on repeated clinic visits (CBP). A total of 133 untreated subjects with diastolic CBP 90 – 115 mmHg on the initial visit were evaluated with HBP (6 workdays), ABP monitoring (2 occasions) and CBP (5 visits within 3 months). The diagnostic value of the HBP and the ABP method was compared to the conventional CBP strategy. Hypertension was diagnosed in 57%, 54% and 45% of

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subjects using the CBP, ABP and HBP methods respectively (p⫽NS). Agreement in the diagnosis of hypertension between all three methods was found in 59% of cases. Disagreement between CBP/ABP was found in 27%, CBP/HBP in 28% and ABP/HBP in 28% of cases. The sensitivity, specificity, positive and negative predictive value of ABP to diagnose hypertension correctly were 73%, 73%, 79% and 66% respectively and of HBP 64%, 84%, 85% and 62%. The above parameters for HBP compared to ABP in the detection of white coat hypertension were 67%, 87%, 50% and 93% respectively. These data suggest that indiscriminate use of HBP or ABP monitoring in the evaluation of all subjects with high blood pressure will probably result in confusion and therefore should be discouraged. However, in the detection of white coat hypertension, HBP appears to be useful as a screening test, which, if positive, requires confirmation with ABP monitoring. Key Words: Home blood pressure; ambulatory blood pressure; diagnosis of hypertension; white coat hypertension C006 ISOLATED OFFICE HYPERTENSION (WHITE COAT HYPERTENSION) (IOH) IN A GENERAL POPULATION. THE PAMELA STUDY R. Sega, M. Bombelli, G.C. Cesana, A. Vertemati, F. Mandelli, L. Corbella, A. Lanzarotti, P. Chiodini, S. Carugo, G. Mancia. Chair of Internal Medicine, S. Gerardo Hospital Monza, University of Milan, Italy IOH is commonly identified with the presence of high values of blood pressure when taken in the clinical environment (Office BP), and “normal” values when measured by other methods, such as ambulatory blood pressure monitoring (ABP) or self measurement at home (Home BP). Whether or not IOH has an adverse prognostic value is controversial. Aim of our study is to evaluate whether in the general population of the PAMELA study IOH is accompanied by an increased or a normal left ventricular mass and thus has an adverse prognostic significance or not. The PAMELA study was performed from 1989 to 1993, on the population of Monza. 3200 subjects aged 25 to 74 years were randomly selected according to the WHO MONICA criteria, and stratified for gender and age (decades). In all subjects left ventricular mass index (LVMI) was assessed by echocardiography. The participation rate was 64%. Based on PAMELA results, the 24 h averages ABP separating ambulatory normotension from hypertension were 125/79 mmHg respectively for SBP and DBP whereas those separating office normotension from hypertension were 140/90 mmHg. We called N subjects with both ABP and Office BP lower than the reference values, H subjects with both ABP and Office BP higher than the reference values, IOH subjects with Office BP ⬎140 and/or 90 mmHg and ABP ⬍125 and 79 mmHg. NABP were subjects with normal Office BP and ABP ⬎125 and/or 79 mmHg. The relative prevalence and LVMI for the four groups are shown in the following table: Except between IOH and NABP, all differences in LVMI were statistically significant (p⬍.001). The differences re-