Morning and smooth 24-h ambulatory blood pressure control is not achieved in general practice

Abstract

The aim of this large-scale, practice-based observational study [Survey with HBPM and ABPM Under Real clinical conditions in General practice to Evaluate BP control in the early morning (SURGE)] was to ascertain the degree of morning and 24-h ambulatory blood pressure (ABP) control in hypertensive patients. Hypertensive patients [with uncontrolled clinic blood pressure (BP) >140/90 mmHg at screening] from nine different countries were included. Ambulatory BP monitoring was performed over 24 h at 15-min intervals during the day and at 20-min intervals during the night. Assessments included morning (0600-1159 h) and daytime ABP control (BP < 135/85 mmHg), and 24-h ABP control, which was set at levels less than 125/80 mmHg (ESH/ESC guidelines) and less than 130/80 mmHg (USA guidelines). A total of 3312 patients were enrolled [mean clinic BP: 153 ± 17/91 ± 10 mmHg; mean 24-h and morning ABP: 130 ± 15/77 ± 10 mmHg and 134 ± 16/80 ± 11 mmHg, respectively; antihypertensive use: 72.7% (n = 2409)]. Morning and daytime (period of activity) ABP control was observed in 45.2 and 47.4% of treated patients, respectively; 24-h ABP control was only achieved in 34.6% (ESH/ESC guidelines) and 44.7% (USA guidelines) of treated patients. There was 'poor agreement' between clinic BP and ABP regarding BP control as shown by a negative (≤0) κ coefficient in treated patients. Clinic BP control (<130/80 mmHg) and morning ABP control (<135/85 mmHg) was observed in 2.3 and 45.1% of diabetic patients, and in 2.4 and 43.6% of patients with left ventricular hypertrophy (LVH). Morning ABP control was 42.3% in patients with high/very high cardiovascular risk. Clinic BP, morning and 24-h ABP control rates were low in treated hypertensive patients, including those with comorbidities, such as diabetes or LVH.