Prognostic value of ambulatory blood pressure monitoring in treated hypertensive patients


Saoussen Antit
Ridha Fekih
Cyrine Antit
Marwa Abdelhedi
Elhem Boussabeh
Lilia Zakhama


Introduction : Ambulatory blood pressure monitoring (AMBP) has become a valuable tool for analyzing patient blood pressure (BP) pro-file to make a more accurate prognosis compared to clinical office BP.
Aim: To identify the prognostic value of different parameters of ABPM and the future course of cardiovascular events (CVE) in treated hypertensive patients.

Methods : We conducted a prospective, descriptive study, including treated hypertensive patients which had consulted between 2015 and 2016 and had a systematic ABPM during their follow-up. Patients were followed at the outpatient clinics for 4 years, and we searched in the computerized medical file the occurrence of CVE.

Results : A total of 240 patients were included in our study with masculine predominance (57%). The mean age was 57.4±9.5 years. During 4 years of follow-up, 30 patients (12.5%) experienced a CVE. The total number of CVE was 32: acute heart failure (3), acute co-ronary syndrome (15), atrial fibrillation (12), stroke (2). Daytime systolic blood pressure (SBP), night-time SBP, 24-h SBP and 24-h pulse pressure (PP), had similar performances to predict CVE. Only the 24-h PP (OR= 1.072; 95% IC: 1.019-1.128; p= 0.007) was found to be an independent predictor of CVE. A 24-h PP> 55 mmHg increased the risk of CVE by 3.2.

Conclusion : SBP and PP were associated with CVE in treated hypertensive patients. the 24-h PP was found to be an independent pre-dictor of CVE so it may serve as a therapeutic target in hypertension therapy.


Ambulatory blood pressure monitoring, hypertension, prognosis



  1. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal. 2018;39(33):3021‑104. DOI: 10.1093/eurheartj/ehy339
  2. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. The Lancet. 2002;360(9349):1903‑13. DOI: 10.1016/S0140-6736(02)11911-8
  3. Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. The Lancet. 2003;362(9395):1527‑35. DOI: 10.1016/S0140-6736(03)14739-3
  4. Dolan E, Stanton A, Thijs L, Hinedi K, Atkins N, McClory S, et al. Superiority of Ambulatory Over Clinic Blood Pressure Measurement in Predicting Mortality: The Dublin Outcome Study. Hypertension. 2005;46(1):156‑61. DOI: 10.1161/01.HYP.0000170138.56903.7a
  5. Kikuya M, Ohkubo T, Asayama K, Metoki H, Obara T, Saito S, et al. Ambulatory Blood Pressure and 10-Year Risk of Cardiovascular and Noncardiovascular Mortality: The Ohasama Study. Hypertension. 2005;45(2):240‑5. DOI: 10.1161/01.HYP.0000152079.04553.2c
  6. Sega R, Facchetti R, Bombelli M, Cesana G, Corrao G, Grassi G, et al. Prognostic Value of Ambulatory and Home Blood Pressures Compared With Office Blood Pressure in the General Population: Follow-Up Results From the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) Study. Circulation. 2005;111(14):1777‑83. DOI: 10.1161/01.CIR.0000160923.04524.5B
  7. Hansen TW, Kikuya M, Thijs L, Björklund-Bodegård K, Kuznetsova T, Ohkubo T, et al. Prognostic superiority of daytime ambulatory over conventional blood pressure in four populations: a meta-analysis of 7030 individuals. Journal of Hypertension. 2007;25(8):1554‑64. DOI: 10.1097/HJH.0b013e3281c49da5
  8. Clement DL, De Buyzere ML, De Bacquer DA, de Leeuw PW, Duprez DA, Fagard RH, et al. Prognostic Value of Ambulatory Blood-Pressure Recordings in Patients with Treated Hypertension. N Engl J Med. 2003;348(24):2407‑15. DOI: 10.1056/NEJMoa022273
  9. Verdecchia P, Porcellati C, Schillaci G, Borgioni C, Ciucci A, Battistelli M, et al. Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension. Hypertension. 1994;24(6):793‑801. DOI: 10.1161/01.HYP.24.6.793
  10. Boggia J, Li Y, Thijs L, Hansen TW, Kikuya M, Björklund-Bodegård K, et al. Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study. The Lancet. 2007;370(9594):1219‑29. DOI: 10.1016/S0140-6736(07)61538-4
  11. Ben-Dov IZ, Kark JD, Ben-Ishay D, Mekler J, Ben-Arie L, Bursztyn M. Predictors of All-Cause Mortality in Clinical Ambulatory Monitoring: Unique Aspects of Blood Pressure During Sleep. Hypertension. 2007;49(6):1235‑41. DOI: 10.1161/HYPERTENSIONAHA.107.087262
  12. Fagard RH, Celis H, Thijs L, Staessen JA, Clement DL, De Buyzere ML, et al. Daytime and Nighttime Blood Pressure as Predictors of Death and Cause-Specific Cardiovascular Events in Hypertension. Hypertension. 2008;51(1):55‑61. DOI: 10.1161/HYPERTENSIONAHA.107.100727
  13. Redon J, Campos C, Narciso ML, Rodicio JL, Pascual JM, Ruilope LM. Prognostic Value of Ambulatory Blood Pressure Monitoring in Refractory Hypertension: A Prospective Study. Hypertension. 1998;31(2):712‑8. DOI: 10.1161/01.HYP.31.2.712
  14. Dolan E, Stanton AV, Thom S, Caulfield M, Atkins N, McInnes G, et al. Ambulatory blood pressure monitoring predicts cardiovascular events in treated hypertensive patients – an Anglo-Scandinavian cardiac outcomes trial substudy. Journal of Hypertension. 2009;27(4):876‑85. DOI: 10.1097/HJH.0b013e328322cd62
  15. Lempiäinen PA, Ylitalo A, Huikuri H, Kesäniemi YA, Ukkola OH. Nighttime ambulatory pulse pressure predicts cardiovascular and all‐cause mortality among middle‐aged participants in the 21‐year follow‐up. J Clin Hypertens. 2021;23(8):1547‑55. DOI: 10.1111/jch.14317
  16. Tadic M, Quarti-Trevano F, Bombelli M, Facchetti R, Cuspidi C, Mancia G, et al. The importance of pulse pressure on cardiovascular risk and total mortality in the general population: Is sex relevant? J Clin Hypertens. 2018;20(6):1001‑7. DOI: 10.1111/jch.13300
  17. Franklin SS, Gustin W, Wong ND, Larson MG, Weber MA, Kannel WB, et al. Hemodynamic Patterns of Age-Related Changes in Blood Pressure: The Framingham Heart Study. Circulation. 1997;96(1):308‑15. DOI: 10.1161/01.CIR.96.1.308
  18. Khattar RS, Swales JD, Dore C, Senior R, Lahiri A. Effect of Aging on the Prognostic Significance of Ambulatory Systolic, Diastolic, and Pulse Pressure in Essential Hypertension. Circulation. 2001;104(7):783‑9. DOI: 10.1161/hc3201.094227
  19. Wing LMH, Chowdhury EK, Reid ChristopherM, Beilin LJ, Brown MA. Night-time ambulatory blood pressure is the best pretreatment blood pressure predictor of 11-year mortality in treated older hypertensives. Blood Pressure Monitoring. 2018;23(5):237‑43. DOI: 10.1097/MBP.0000000000000331
  20. Staessen J. Ambulatory pulse pressure aspredictor of outcome in older patients with systolic hypertension. American Journal of Hypertension. 2002;15(10):835‑43. DOI: 10.1016/S0895-7061(02)02987-4
  21. Kanoun F, Alaya NB, Idriss S, Sayem N, Chihaoui M, Harzallah F, et al. Appréciation du profil tensionnel par mesure ambulatoire de la pression artérielle chez les diabétiques hypertendus traités. LA TUNISIE MEDICALE. 2010;88.
  22. Zhang Z, Gu X, Tang Z, Guan S, Liu H, Wu X, et al. Associations of blood pressure components with risks of cardiovascular events and all-cause death in a Chinese population: A Prospective Study. The Journal of Clinical Hypertension. 2022;24(7):825‑37. DOI: 10.1111/jch.14529
  23. Goff DC, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, et al. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25_suppl_2). DOI: 10.1161/01.cir.0000437741.48606.98
  24. Selvaraj S, Steg PhG, Elbez Y, Sorbets E, Feldman LJ, Eagle KA, et al. Pulse Pressure and Risk for Cardiovascular Events in Patients With Atherothrombosis. Journal of the American College of Cardiology. 2016;67(4):392‑403. DOI: 10.1016/j.jacc.2015.10.084
  25. Myers MG, Kaczorowski J, Paterson JM, Dolovich L, Tu K. Thresholds for Diagnosing Hypertension Based on Automated Office Blood Pressure Measurements and Cardiovascular Risk. Hypertension. 2015;66(3):489‑95. DOI: 10.1161/HYPERTENSIONAHA.115.05782
  26. Flint AC, Conell C, Ren X, Banki NM, Chan SL, Rao VA, et al. Effect of Systolic and Diastolic Blood Pressure on Cardiovascular Outcomes. N Engl J Med. 2019;381(3):243‑51. DOI: 10.1056/NEJMoa1803180
  27. Williams B, Lindholm LH, Sever P. Systolic pressure is all that matters. The Lancet. 2008;371(9631):2219‑21. DOI: 10.1016/S0140-6736(08)60804-1
  28. McEvoy JW, Daya N, Rahman F, Hoogeveen RC, Blumenthal RS, Shah AM, et al. Association of Isolated Diastolic Hypertension as Defined by the 2017 ACC/AHA Blood Pressure Guideline With Incident Cardiovascular Outcomes. JAMA. 2020;323(4):329. DOI: 10.1001/jama.2019.21402
  29. Carlsson AC, Johansson S-E, Theobald H, Wändell PE. Blood pressure measures and their predictive ability of cardiovascular mortality: a 26-year follow-up. Blood Pressure Monitoring. 2013;18(2):72‑7. DOI: 10.1097/MBP.0b013e32835ea233
  30. Powell TM, Glynn RJ, Buring JE, Creager MA, Ridker PM, Pradhan AD. The relative importance of systolic versus diastolic blood pressure control and incident symptomatic peripheral artery disease in women. Vasc Med. 2011;16(4):239‑46. DOI: 10.1177/1358863X11413166
  31. Wei F-F, Li Y, Zhang L, Xu T-Y, Ding F-H, Staessen JA, et al. Association of Target Organ Damage With 24-Hour Systolic and Diastolic Blood Pressure Levels and Hypertension Subtypes in Untreated Chinese. Hypertension. 2014;63(2):222‑8. DOI: 10.1161/HYPERTENSIONAHA.113.01940
  32. Roman MJ, Devereux RB, Kizer JR, Okin PM, Lee ET, Wang W, et al. High Central Pulse Pressure Is Independently Associated With Adverse Cardiovascular Outcome. Journal of the American College of Cardiology. 2009;54(18):1730‑4. DOI: 10.1016/j.jacc.2009.05.070
  33. Anderson RJ, Bahn GD, Emanuele NV, Marks JB, Duckworth WC, for the VADT Study Group. Blood Pressure and Pulse Pressure Effects on Renal Outcomes in the Veterans Affairs Diabetes Trial (VADT). Diabetes Care. 2014;37(10):2782‑8. DOI: 10.2337/dc14-0284
  34. The SPRINT Research Group. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015;373(22):2103‑16. DOI: 10.1056/NEJMoa1511939
  35. Franklin SS, Larson MG, Khan SA, Wong ND, Leip EP, Kannel WB, et al. Does the Relation of Blood Pressure to Coronary Heart Disease Risk Change With Aging?: The Framingham Heart Study. Circulation. 2001;103(9):1245‑9. DOI: 10.1161/01.CIR.103.9.1245
  36. Williams C, Kingwell BA, Burke K, McPherson J, Dart AM. Folic acid supplementation for 3 wk reduces pulse pressure and large artery stiffness independent of MTHFR genotype. The American Journal of Clinical Nutrition. 2005;82(1):26‑31. DOI: 10.1093/ajcn/82.1.26