OFFICE, HOME AND AMBULATORY BLOOD PRESSURE LONG-TERM CHANGES IN THE GENERAL POPULATION

Abstract

Objective: The PAMELA is an epidemiological study performed on a population sample, including office, home and 24 h ambulatory blood pressure (BP) measurements. Measurements were made at baseline, after 11 years, and repeated in a 3rd survey 26 years later. Design and method: 3200 subjects were randomly selected to represent the population of Monza (North Italy) aged 25–74 years. In each subject body mass index (BMI), office (sphygmomanometer), home (semiautomatic validated device), 24 h (validated automatic oscillometric device) systolic (S) and diastolic (D) BP measurements, heart rate (HR) and biochemical variables were obtained. All values were measured at baseline (1st survey, 1990–91), 11 years later (2nd survey, 2001–02) and after further 15 years (3rd survey, 2016–17). Results: 562 subjects (279/283 males/females, mean age 41 ± 10 yrs) participated at the 3 surveys. Baseline average office, home and 24 h SBP/DBP were respectively 122/81 ± 14/9, 116/73 ± 15/10, 116/73 ± 9/7 mmHg and increased respectively of 5/1 ± 14/9, 4/1 ± 14/9 and 4/2 ± 10/7 mmHg at the 2nd survey. At the 3rd survey a further increase of 11/2 ± 7/11, 8/3 ± 16/10 and 13/2 ± 15/9 mmHg was observed in office, home and 24 h BP respectively. The baseline-3rd survey office, home and 24 h SBP difference was unrelated to age, while the DBP increase was inversely related to age (r = −0.32, −0.39 and −0.38, respectively, P < 0.0001). The baseline-3rd survey increase in office, home and 24 h DBP was significantly directly related to the concomitant BMI increase (r = 0.23, 0.17 and 0.14, respectively, P < 0.005). Office and home HR was similar in the 3 surveys. A reduction in 24 h HR was detected between the 1st and 3rd survey (−4.0 ± 8.2 b/min). At baseline hypertensive subjects were 22.2% (office BP), 19.3% (home BP) and 20.7% (24 h BP), and increased to 37.7%, 33.8% and 43.5% at the 2nd survey and to 68.7%, 65.8% and 80.8% at the 3rd survey respectively. Conclusions: The PAMELA 26-year follow-up represents the longest survey ever done describing the long-term changes of BP measurements in general population. It shows a long-term increase in office, home and 24 h BP only partially accompanied by HR changes, and an increase in the prevalence of hypertension, particularly pronounced when defined with 24 h measurements.