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Out‐of‐office and central blood pressure for risk stratification: a cross‐sectional study in patients treated for hypertension
Author(s) -
Schultz Martin G.,
Gilroy Deborah,
Wright Leah,
Bishop Warrick L. J.,
Abhayaratna Walter P.,
Stowasser Michael,
Sharman James E.
Publication year - 2012
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/j.1365-2362.2011.02595.x
Subject(s) - blood pressure , cross sectional study , medicine , risk stratification , stratification (seeds) , cardiology , emergency medicine , pathology , seed dormancy , botany , germination , dormancy , biology
Eur J Clin Invest 2012; 42 (4): 393–401 Abstract Background Central blood pressure (BP) predicts mortality independent of office brachial BP. Whether central BP may be useful to differentiate BP control requires examination and was the first aim of this study. Secondly, we sought to determine the variability in central BP among patients from different categories of BP control [controlled hypertension (CH), masked hypertension (MH), white coat (WCHT) and uncontrolled hypertension (UH)]. Materials and methods We assessed patients with uncomplicated hypertension using measurement of central BP (SphygmoCor 8.1), brachial BP and 24‐h ambulatory BP monitoring. BP control was defined according to guidelines using office BP and 24‐h BP. Results Of the 201 patients (63 ± 8 years, 51% men), 67 (33%) were classified as CH; 59 (29%) with MH; 31 (15%) with WCHT; and 44 (22%) with UH. There were no differences in central BP parameters (augmentation pressure, augmentation index, pulse pressure) between patients with CH and MH or between patients with WCHT and UH ( P > 0·05 for all). However, there was significant overlap in central systolic BP between BP control categories. For example, 27% of patients with normal brachial systolic BP had central systolic BP above age‐ and gender‐specific normal values, including patients from three classifications of BP control (CH: n = 27; MH: n = 22; and WCHT: n = 4). Conclusion Office central BP alone cannot delineate categories of BP control. However, given the high degree of variability in central BP among patients from different categories of BP control, measurement of central BP may result in significant reclassification of risk related to BP.