Prognostic value of ambulatory blood pressure measurement in treated hypertensive patients

Abstract

Cardiovascular risk is directly correlated to the circadian blood pressure profile. The aim of this work was to evaluate the ambulatory blood pressure measurement (ABPM) parameters that can predict the occurrence of cardiovascular events over medium term. We conducted a prospective descriptive study of 240 hypertensive patients who were treated and who had had ABPM during their follow-up at the cardiology department of the hospital of the internal security forces of Marsa, with consultations between 2015 and 2016. The mean age of our population was 57.4 ± 9.54 years, with a sex ratio of 1.33. Diabetes was the most common risk factor associated with hypertension (42.1%), followed by obesity (39.2%). This is a high cardiovascular risk population with 61% of patients with 3 or more risk factors and 56.9% with high and very high-risk according to the SCORE score. The MAPA analysis showed that the mean 24-hour SSP was 129.5 ± 14 mmHg and the mean 24-hour MAP was 74.7 ± 9.8 mmHg. Electrical HVG was found in 7.2% of patients. Microalbuminuria was documented in 31.5% of patients and proteinuria in 6.8% of patients. Forty-three cardiovascular events were identified during the 4-year follow-up of our patients with a mean time to onset of 14.5 ± 9 months. In univariate analysis, there was a significant difference between patients with and without a cardiovascular event in terms of age ( P = 0.026), mean SBP both overall ( P = 0.011), diurnal ( P = 0.042) and nocturnal ( P = 0.005), maximum DBP ( P = 0.035) and PP ( P = 0.001). In multivariate analysis, the independent factors associated with cardiovascular events were mean nocturnal SBP (OR = 1.04; CI = 1.01–1.07; P = 0.001) and maximum DBP (OR = 0.96; CI = 0.92–0.99; P = 0.02). ABPM is an interesting prognostic tool in hypertensive patients, allowing the prediction of long-term cardiovascular events.