HDCN Article Review/Hyperlink

Mancia G, Sega R, Milesi C, Cesana G, Zanchetti A

Blood pressure control in the hypertensive population

Lancet (Feb) 349:454-457 1997

The authors of this study have re-analyzed the data from their previously published database in Italy (PAMELA). The purpose of the present analysis is to assess the overall blood pressure (BP) control of the group as judged by office, ambulatory and home blood pressure.

The entire group consisted of 2400 individuals selected at random from the town of Monza. Only 1651 subjects participated. They all underwent standardized office BP measurement by a physician, 2 home BP measurements, and ambulatory BP monitoring. Appropriate precautions were taken to ensure good data quality from the ambulatory studies. The group had a mean age of 46 years and almost equal numbers of men and women were included. Of the hypertensives (defined as office BP >140 mm Hg and/or 90 mm Hg) there were 402 untreated and 207 treated hypertensives. The untreated subjects as well as treated hypertensives had higher mean clinic BP, home and ambulatory BP than did their normotensive counterparts. In 28% of treated subjects, BP control was judged good (<140/90 mm Hg). When the authors used a cut-off of 123/77 mm Hg for normal 24-hour ambulatory BP, they found that only 36% of the treated patients were well controlled.

The authors conclude that the high office BP seen is consistent with poor BP control as judged by home and ambulatory BP. They then indicate that subjects with white-coat effect are indeed generally poorly controlled. However the study has several problems which may not be obvious. Firstly this is not a randomized study and so subjects who are being treated for hypertension had higher BPs to start with; it is not unexpected that their BPs would remain close to those of untreated (presumably less hypertensive and hence why not on treatment) patients. Also, the cut-off for normal 24 hour BP is well below the accepted 95th percentile of normotensives (Allied Irish Bank study and other population studies). The study does show, however, that patients in Italy, as in the United States, have less than optimal BP control. (George Mansoor, M.D., University of Connecticut)

The abstract of this paper is available from the National Library of Medicine's PubMed site: click here .