Abstract
The present investigation was aimed at determining the prevalence and the blood pressure (BP) profile of isolated ambulatory hypertension, defined as an elevated ambulatory BP with normal office blood pressure, in a series of 1488 consecutive outpatients referred for routine clinical evaluation of suspected or established arterial hypertension. All patients underwent both office BP (OBP) measurement by a physician and 24-h ambulatory blood pressure monitoring (ABPM). Using OBP values (cutoff for diagnosis of hypertension ⩾140/90 mmHg) and daytime ABPM (cutoff for diagnosis of hypertension ⩾135/85 mmHg), patients were classified into eight subgroups. In the whole series we found that, independent of treatment status, the prevalence of isolated ambulatory hypertension exceeded 10%. More importantly, 45.3% of individuals who presented with normal OBP values, showed elevated BP at ABPM. Night-time BP, 24-h pulse pressure, and BP variability were significantly higher in isolated ambulatory hypertensives than in normotensive or in white-coat hypertensive individuals. Therefore, isolated ambulatory hypertension is characterized by a blood pressure profile that is similar to that observed in sustained hypertension. These findings suggest that isolated ambulatory hypertension is very common and probably the indications for ABPM should be more extensive in outpatients referred to hypertensive centre.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 digital issues and online access to articles
$119.00 per year
only $9.92 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Staessen JA et al. Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic Hypertension Europe Trial Investigators. JAMA 1999; 282: 539–546.
Mancia G, Parati G . Ambulatory blood pressure monitoring and organ damage. Hypertension 2000; 36: 894–900.
Musso NR, Giacchè M, Galbariggi G, Vergassola C . Blood pressure evaluation by noninvasive and traditional methods. Consistencies and discrepancies among photoplethysmomanometry, office sphygmomanometry, and ambulatory monitoring. Effects of blood pressure measurement. Am J Hypertens 1996; 9: 293–299.
Mancia G et al. Effects of blood pressure measurements by the doctor on patient's blood pressure and heart rate. Lancet 1983; 8352: 695–698.
Pickering TG et al. How common is white coat hypertension. JAMA 1988; 259: 225–228.
Liu JE et al. Cardiac an arterial target organ damage in adults with elevated ambulatory and normal office blood pressure. Ann Intern Med 1999; 131: 564–572.
Sega R et al. Alterations of cardiac structure in patients with isolated office, ambulatory, or home hypertension: data from the general population (Pressione Arteriose Monitorate E Loro Associazioni [PAMELA] Study). Circulation 2001; 104: 1385–1392.
Wing LMH et al. Reverse white-coat hypertension' in older hypertensives. J Hypertens 2002; 20: 639–644.
Owens P, Atkins N, O'Brien E . Diagnosis of white coat hypertension by ambulatory blood pressure monitoring. Hypertension 1999; 34: 267–272.
Cavallini MC et al. Is white coat hypertension associated with arterial disease or left ventricular hypertrophy? Hypertension 1995; 26: 413–419.
Schillaci G et al. Clinical relevance of office underestimation of usual blood pressure in treated hypertension. Am J Hypertens 2000; 13: 523–528.
Verdecchia P et al. Independent predictors of isolated clinic (‘white-coat’) hypertension. J Hypertens 2001; 19: 1015–1020.
Björklund K et al. Isolated ambulatory hypertension predicts cardiovascular morbidity in elderly man. Circulation 2003; 107: 1297–1302.
O'Brien E, Mee F, Atkins N, O'Malley K . Accuracy of the SpaceLabs 90207 determined by the British Hypertension Society protocol. J Hypertens 1991; 9: 573–574.
O'Brien E, Mee F, Atkins N, O'Malley K . Accuracy of the SpaceLabs 90207, Novacor DIASYS 200, Del Mar Avionics Pressurometer IV and Takeda TM-2420 ambulatory systems according to British and American criteria. J Hypertens Suppl 1991; 9: S332–S333.
Maxwell MH et al. Error in blood-pressure measurement due to incorrect cuff size in obese patients. Lancet 1982; 8288: 33–36.
Synder F et al. Changes in respirations, heart rate, and systolic pressure in human sleep. J Appl Physiol 1964; 19: 417–422.
Pickering TG . The clinical significance of diurnal blood pressure variations. Dippers and nondippers. Circulation 1990; 81: 700–702.
Kario K et al. Nocturnal fall of blood pressure and silent cerebrovascular damage in elderly hypertensive patients. Advanced silent cerebrovascular damage in extreme dippers. Hypertension 1996; 27: 130–135.
The Seventh Report of the Joint National Committee on Prevention. Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003; 289: 2560–2572.
Verdecchia P et al. Ambulatory pulse pressure. A potent predictor of total cardiovascular risk in hypertension. Hypertension 1998; 32: 983–988.
Mancia G et al. Ambulatory blood pressure normality: results from the PAMELA study. J Hypertens 1995; 13: 1377–1390.
Mancia G et al. Alerting reaction and rise in blood pressure during measurement by physician and nurse. Hypertension 1987; 9: 209–215.
Clement DL et al. for the Office versus Ambulatory Pressure Study Investigators. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med 2003; 348: 2407–2415.
Guidelines Subcommittee. 1999 World Health Organization-International Society of Hypertension Guidelines for the management of hypertension. J Hypertens 1999; 17: 151–183.
Verdecchia P et al. Risk of cardiovascular disease in relation to achieved office and ambulatory blood pressure control in treated hypertensive subjects. J Am Coll Cardiol 2002; 39: 878–885.
Guidelines Committee. 2003 European Society of Hypertension — European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21: 1011–1053.
Acknowledgements
This study is supported by Hy-Oldest project (Hypertension in the OLDEr Subject in Tuscany Project). We are indebt to the physicians and the nurses of the Hypertension Centre, Unit of Gerontology and Geriatrics, Department of Critical Care Medicine and Surgery, particularly to Mr Alessandro Marilli and Mrs M Conforti for their help in the nursing assistance.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ungar, A., Pepe, G., Monami, M. et al. Isolated ambulatory hypertension is common in outpatients referred to a hypertension centre. J Hum Hypertens 18, 897–903 (2004). https://doi.org/10.1038/sj.jhh.1001756
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.jhh.1001756
Keywords
This article is cited by
-
Options for the diagnosis of high blood pressure in primary care: a systematic review and economic model
Journal of Human Hypertension (2021)
-
Diagnostic performance of clinic and home blood pressure measurements compared with ambulatory blood pressure: a systematic review and meta-analysis
BMC Cardiovascular Disorders (2020)
-
High Sodium Intake Is Associated With Masked Hypertension in Japanese Patients With Type 2 Diabetes and Treated Hypertension
American Journal of Hypertension (2012)
-
Masked Hypertension: Evidence of the Need to Treat
Current Hypertension Reports (2010)
-
Association of Passive Smoking With Masked Hypertension in Clinically Normotensive Nonsmokers
American Journal of Hypertension (2009)