24-hour ambulatory BP measurements strongly predict mortality

The investigation by Dr. Banegas and colleagues confirms that ambulatory blood pressure monitoring is useful for assessing blood pressure, the most important and treatable factor contributing to death and disability.

The registry study addresses several clinically relevant issues. In particular, ambulatory blood pressure measures more strongly predicted all-cause and cardiovascular mortality as compared with blood pressure measured in the clinic.

Moreover, the highest hazard ratio of death was seen in patients with masked hypertension, or those with normal clinic-measured blood pressure but elevated ambulatory measurements.

Finally, patients with white coat hypertension (elevated clinic but normal ambulatory blood pressure) had a risk of cardiovascular death twice as high as patients with normal clinic and ambulatory values.

The ominous effect of white coat hypertension has been noted by others, and it is probably related to the increasing magnitude (that is, the difference between clinic blood pressure and ambulatory blood pressure) to white coat hypertension with age.

Ambulatory blood pressure monitoring equipment has evolved and is much lighter than in the past, making it more acceptable to patients.

With more patients undergoing ambulatory blood pressure monitoring, several countries established ambulatory monitoring registries, such as the Spanish registry evaluated in this study.

Ultimately, one hopes the results of this registry study would serve as one more spur to providers and device manufacturers to initiate a registry in the United States.

Raymond R. Townsend, MD, is from the University of Pennsylvania, Philadelphia. These comments are based on his editorial that appeared in the New England Journal of Medicine . Dr. Townsend reported disclosures related to Medtronic, AXIO, and CLARUS Therapeutics, among others.