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Systolic vs Diastolic Blood Pressure Control in the Hypertensive Patients of the PAMELA Population
Giuseppe Mancia, MD;
Michele Bombelli, MD;
Arturo Lanzarotti, MD;
Guido Grassi, MD;
GianCarlo Cesana, MD;
Alberto Zanchetti, MD;
Roberto Sega, MD
Arch Intern Med. 2002;162:582-586.
Background Previous studies have shown that in the treated fraction of the hypertensive
population, blood pressure (BP) control is less common for systolic BP (SBP)
than for diastolic BP (DBP) as measured in the physician's office. Whether
this phenomenon is artifactually attributable to a temporary increase in BP
owing to a "white-coat" effect or represents a true rarity of SBP control
in daily life is unknown.
Methods Data were obtained from the PAMELA (Pressioni Arteriose Monitorate E
Loro Associazioni) study population, which involved individuals ranging in
age from 25 to 74 years who were representative of the residents of Monza
(a city near Milan, Italy) and who were stratified according to sex. Office
(an average of 3 sphygmomanometric measurements), home (an average of morning
and evening self-measurements using a semiautomatic device), and 24-hour ambulatory
(average of measurements performed every 20 minutes during the day and at
night) BP values were obtained in all study subjects. In the treated hypertensive
patients, BP was regarded as controlled if office values were less than 140
(SBP) or 90 (DBP) mm Hg. Home and 24-hour average SBP and DBP were regarded
as controlled if the values were lower than 132/83 and 125/79 mm Hg, respectively.
Results In the study participants (n = 2051), the number of patients with hypertension
who were receiving antihypertensive treatment was 398, or approximately 42%
of all individuals with hypertension. In-office SBP control by treatment was
less frequent than DBP control (29.9% vs 41.5%, P<.05).
This was also the case when home and 24-hour SBP and DBP control was considered
(38.3% vs 54.6% and 50.8 vs 64.9%, respectively, P<.05
for both).
Conclusions In the PAMELA population, SBP control by treatment was much less frequent
than DBP control by treatment. This was the case not only for office BP values
but also for home and 24-hour BP values, demonstrating that inadequate SBP
control is not limited to artificial BP-measuring methods but occurs in daily
life.
From Clinica Medica (Drs Mancia, Bombelli, Lanzarotti, Grassi, and
Sega) and Clinica del Lavoro (Dr Cesana), Università di Milano-Bicocca,
Ospedale San Gerardo, Monza, Italy; and Istituto Auxologico Italiano (Drs
Mancia, Grassi, and Zanchetti) and Centro Fisiologia Clinica e Ipertensione,
Università Milano (Drs Mancia, Grassi, and Zanchetti), Milano, Italy.
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