Value of ambulatory intra-arterial blood pressure monitoring in the long term prediction of left ventricular hypertrophy and carotid atherosclerosis in essential hypertension

The aim of this study was to compare the abilities of clinic and ambulatory blood pressure (BP) to predict the long term occurrence of left ventricula r hypertrophy and carotid atherosclerosis in uncomplicated hypertensive pat ients. Two hundred and ninety-five patients who had undergone 24-h ambulato ry intra-arterial BP monitoring on the basis of an elevated clinic BP, atte nded followup at a mean of 10.2 (+/-3.5) years later. This consisted of a h istory, physical examination, risk factor profile and serum cholesterol lev el. Echocardiography and carotid ultrasonography were also performed to det ermine left ventricular mass index and maximal intima-media thickness (IMTm ax), a measure of carotid atherosclerosis severity. The factors most strong ly correlated with both left ventricular mass index and IMTmax were age, 24 -h mean pulse pressure and 24-h mean systolic BP. Age, 24-h mean systolic B P and body mass index were independent correlates of left ventricular hyper trophy (R-2 = 17%), whereas age, 24-h mean pulse pressure and pack years we re independent predictors of carotid atherosclerosis (R-2 = 34%). Clinic BP did not feature in the final model for the long term prediction of cardiov ascular end-organ damage. These findings promote a role for ambulatory BP m onitoring in guiding aggressiveness of drug therapy in an attempt to limit potential target organ damage.