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
Abstract
Background— Studies in hypertensive patients suggest that ambulatory blood pressure (BP) is prognostically superior to office BP. Much less information is available in the general population, however. Obtaining this information was the purpose of the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study. Methods and Results— Office, home, and 24-hour ambulatory BP values were obtained in 2051 subjects between 25 and 74 years of age who were representative of the general population of Monza (Milan, Italy). Subjects were followed up for an average of 131 months, during which time cardiovascular and noncardiovascular fatal events were recorded (n=186). Office, home, and ambulatory BP values showed a significant exponential direct relationship with risk of cardiovascular or all-cause death. The goodness of fit of the relationship was greater for systolic than for diastolic BP and for night than for day BP, but its overall value was not better for home or ambulatory than for office BP. The slope of the relationship, however, was progressively greater from office to home and ambulatory BP. Home and night BP modestly improved the goodness of fit of the risk model when added to office BP. Conclusions— In the PAMELA population, risk of death increased more with a given increase in home or ambulatory than in office BP. The overall ability to predict death, however, was not greater for home and ambulatory than for office BP, although it was somewhat increased by the combination of office and outside-of-office values. Systolic BP was almost invariably superior to diastolic BP, and night BP was superior to day BP.
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Some but not all studies have suggested that nighttime blood pressure is the strongest predictor of death.
“Some 4,6,9,11 but not all studies 5,10 have suggested that nighttime blood pressure is the strongest predictor of death.”
From Relationship between clinic and ambulatory blood pressure and mortality: an observational cohort study in 59 124 patients (2023) · cites this paper as [5]
Current evidence does not clearly support either home blood pressure or ambulatory blood pressure as the superior method for predicting outcome.
“Current evidence does not clearly support either HBP or ABP as the superior method for predicting outcome [40].”
Home blood pressure self-monitoring and 24-hour ambulatory blood pressure monitoring may provide evidence of white coat hypertension, masked hypertension, or other discrepancies between office and true blood pressure.
“Home blood pressure self-monitoring and 24-h ambulatory blood pressure monitoring may provide evidence of white coat hypertension, masked hypertension, or other discrepancies between of fi ce and ' true ' blood pressure (23,24).”
From 10. Cardiovascular Disease and Risk Management: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [24]
Studies of individuals without diabetes found that home blood pressure measurements may better correlate with ASCVD risk than office measurements.
“Studies of individuals without diabetes found that home measurements may better correlate with ASCVD risk than of fi ce measurements (23,24).”
From 10. Cardiovascular Disease and Risk Management: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [24]
Out-of-clinic blood pressure measurements (home and ambulatory) are more predictive of target organ damage and mortality than clinic measurements in population cohort studies.
“Out-of-clinic BP measurements (i.e. home and ABP) are recognized to be more predictive of target organ damage and mortality in population cohort studies33, 34”
From Dietary Nitrate Provides Sustained Blood Pressure Lowering in Hypertensive Patients: A Randomized, Phase 2, Double-Blind, Placebo-Controlled Study (2015) · cites this paper as [34]
Studies in nondiabetic populations show that home blood pressure measurements may better correlate with CVD risk than office measurements.
“Home blood pressure self-monitoring and 24-h ambulatory blood pressure monitoring may provide additional evidence of “white coat” and masked hypertension and other discrepancies between office and “true” blood pressure, and studies in nondiabetic populations show that home measurements may better correlate with CVD risk than office measurements (161,162).”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [162]
In the absence of severe hypertriglyceridemia, therapy targeting HDL cholesterol or triglycerides lacks the evidence base of statin therapy.
“In the absence of severe hypertriglyceridemia, therapy targeting HDL cholesterol or triglycerides has intuitive appeal but lacks the evidence base of statin therapy (162).”
From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [162]
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- Authors
- Sega, R., Facchetti, R., Bombelli, M., Cesana, G., Corrao, G., Grassi, G., & Mancia, G.
- Affiliations
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- Venue
- Circulation
- Published
- 2005-04-12
- Volume
- 111
- Issue
- 14
- Pages
- 1777-1783
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2065232710
- Cited by
- 1,009
- References
- 0
- Citations by year
- 2026: 18 · 2025: 21 · 2024: 39 · 2023: 46 · 2022: 44 · 2021: 41 · 2020: 43 · 2019: 47 · 2018: 48 · 2017: 39 · 2016: 65 · 2015: 62 · 2014: 63 · 2013: 55 · 2012: 64
- FWCI
- 30.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- BOA (University of Milano-Bicocca) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- ambulatory blood pressure, home blood pressure monitoring, office blood pressure, cardiovascular mortality, all-cause mortality, prognostic value, systolic blood pressure, nocturnal blood pressure, PAMELA study, general population
- MeSH terms
- Adult, Aged, Blood Pressure Determination, Cardiovascular Diseases, Female, Follow-Up Studies, Humans, Italy, Male, Middle Aged, Office Visits, Predictive Value of Tests, Prognosis, Risk Factors, Self Care, Survival Analysis, Blood Pressure Monitoring, Ambulatory
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