Our mission is to become a worldwide reference for education in the field for all professionals involved in the process to dissemintate knowledge & skills of Acute Cardiovascular Care
Our mission is to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular imaging in Europe.
Our mission: To promote excellence in research, practice, education and policy in cardiovascular health, primary and secondary prevention.
Our goal is to reduce the burden in cardiovascular disease in Europe through percutaneous cardiovascular interventions.
Our Mission is "to improve the quality of life of the population by reducing the impact of cardiac rhythm disturbances and reduce sudden cardiac death"
To improve quality of life and logevity, through better prevention, diagnosis and treatment of heart failure, including the establishment of networks for its management, education and research.
Working Groups goals is to stimulate and disseminate scientific knowledge in different fields of cardiology.
ESC Councils goal is to share knowledge among medical professionals practising in specific cardiology domains.
OUR MISSION: TO REDUCE THE BURDEN OF CARDIOVASCULAR DISEASE
Prof. Guido Grassi
The PAMELA study shows that even in the general population the risk of cardiovascular events increases more with a given increase in home or ambulatory than office blood pressure. This finding documents the value of ambulatory (and home) blood pressure in predicting the risk of cardiovascular and all cause death.
Evidence has been provided that all these blood pressures play a prognostic role in the clinical course of the disease and participate at determining the cardiovascular risk profile of a given hypertensive patient. The question, however, is whether and to what extent one of the above mentioned blood pressures may be superior to the others in predicting cardiovascular risk. The answer to this question would have obvious important practical implications for current clinical practice.
Several investigators have documented that office blood pressure values (i.e. the blood pressure values obtained through the sphygmomanometer in the doctor’s office) are usually greater than ambulatory blood pressure values with which they show a limited relationship. This is exemplified by the untreated hypertensive subjects of the European Lacidipine Study on Atherosclerosis (ELSA), in which an office diastolic blood pressure of about 95 mmHg was associated with a wide range of 24-hour average diastolic values (1). It is further exemplified by the treated hypertensive patients of the Hypertension Optimal Treatment (HOT) Study in which office and ambulatory systolic and diastolic blood pressure values showed a very limited relationship to each other (2). It is finally exemplified in an analysis of the large data base our group has collected throughout the years showing that the degree of blood pressure reduction induced by treatment was very different, not only quantitatively but also qualitatively, when assessed by office or ambulatory blood pressure (3).
The limited relationship between different blood pressure measurements poses with strength the question of which blood pressure is prognostically more important, an issue that has been addressed by cross-sectional as well as longitudinal studies.
Cross-sectional data have almost invariably shown that the end-organ damage associated with, and determined by, hypertension is more closely related to 24-hour average than to office blood pressure, no matter where and how the cardiovascular functional and structural alterations are assessed (3).
Longitudinal studies have been less conclusive, however, because in several instances their design was uncontrolled (4). In one study with a controlled design, however, more than 200 hypertensive patients with echocardiographic evidence of left ventricular hypertrophy were followed for one year to assess whether the regression of cardiac structural alterations was more closely related to the treatment-induced reduction of 24 hour or office blood pressure (4). The results of the study show that the reduction in left ventricular mass was significantly related to the fall in 24 hour average systolic and diastolic blood pressure but much less or not so to the concomitant fall in other blood pressure values.
This allows to conclude that daily life blood pressure control by treatment reflects much more accurately than office blood pressure control the improvement of the organ damage, and thus of vital organ protection, accompanying hypertension.
A final consideration on the superiority of ambulatory blood pressure measurements in reflecting target organ damage refers to the evidence that this technique has allowed to show that “white coat hypertension” and “masked hypertension” (Table 1) are associated with structural cardiac alterations (i.e. left ventricular hypertrophy) (5).
Stratifying patients into different risk categories on the basis of ambulatory blood pressure values require studies that
Longitudinal studies of patients with treated or untreated hypertension or diabetes, however, have shown that blood pressure values averaged over the whole or part of the 24 hours predict progression of organ damage or risk of cardiovascular disease better than or in addition to blood pressure values obtained in the office environment (6-8).
This is the case for the Office versus Ambulatory Pressure (OVA) study, that in almost 2000 treated hypertensives has shown the superiority of 24-hour blood pressure values in predicting cardiovascular events (9). This is also the case for the already mentioned Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study, showing the adverse prognostic effects of ambulatory blood pressure elevation (9). This study, however, also showed that each of the available blood pressures (office, home and 24 hour ), when elevated, carries an increase in risk mortality, thereby implying the importance that antihypertensive treatment effectively reduces all these pressures.
A final comment refers to the evidence, again provided by the PAMELA Study, that even in the general population the risk of cardiovascular events increases more with a given increase in home or ambulatory than office blood pressure (10). This finding once again documents the value of ambulatory (and home) blood pressure in predicting the risk of cardiovascular and all cause death.
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.
1. Mancia G, Parati G, Hennig M, et al. Relation between blood pressure variability and carotid artery damage in hypertension: baseline data from the European Lacidipine Study on Atherosclerosis (ELSA). J Hypertens 2001;19:1981-1989. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11677363&query_hl=1&itool=pubmed_docsum 2. Mancia G, Omboni S, Parati G, et al. Twenty-four hour ambulatory blood pressure in the Hypertension Optimal Treatment (HOT) study. J Hypertens 2001;19:1755-1763. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11593094&query_hl=1&itool=pubmed_docsum 3. Mancia G, Omboni S, Ravogli A, et al. Ambulatory blood pressure monitoring in the evaluation of antihypertensive treatment: additional information from a large data base. Blood Press 1995;4:148-156. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8866899&query_hl=4&itool=pubmed_docsum 4. Mancia G, Zanchetti A, Agabiti Rosei E, et al. Ambulatory blood pressure is superior to clinic blood pressure in predicting treatment-induced regression of left ventricular hypertrophy. Circulation 1997;95:1464-1470. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9118514&query_hl=6&itool=pubmed_DocSum 5. Sega R, Trocino G, Lanzarotti A, 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. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11560854&query_hl=7&itool=pubmed_docsum 6. Redon J, Campos C, Narciso ML, et al. Prognostic value of ambulatory blood pressure monitoring in refractory hypertension: a prospective study. Hypertension 1998;31:712-718. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9461245&query_hl=9&itool=pubmed_docsum 7. Khattar RS, Swales JD, Banfield A, et al. Prediction of coronary and cerebrovascular morbidity blood pressure monitoring in essential hypertension. Circulation 1999;100:1071-1076. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10477532&query_hl=12&itool=pubmed_docsum 8. Clement DL, De Buyzere ML, De Bacquer DA, et al. Prognostic value of ambulatory blood pressure in patients with treated hypertension. N Engl J Med 2003;348:2407-2415. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12802026&query_hl=14&itool=pubmed_docsum 9. Mancia G, Facchetti R, Bombelli M, et al. Long-term risk of mortality associated with selective and combined elevation in office, home and ambulatory blood pressure. Hypertension 2006;47:1-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16567588&query_hl=16&itool=pubmed_docsum 10. Mancia G, Facchetti R, Bombelli M, 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;111:1777-1783. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15809377&query_hl=18&itool=pubmed_DocSum
© 2016 European Society of Cardiology. All rights reserved