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Abstract
This article is a critical review of the available evidence on the prognostic value
of ambulatory blood pressure (ABP). Several event-based cohort studies have shown
that ABP improves cardiovascular risk stratification over and beyond traditional risk
factors, including office BP. Most of these studies have been conducted in subjects
with essential hypertension who were untreated at the time of execution of ABP monitoring;
other studies have been conducted in subjects who were poorly controlled with treatment
or in the general population. In these studies, ABP was examined as a continuous variable
or with operational risk categories. Cardiovascular risk showed a direct and independent
association with the observed ABP (systolic, diastolic, and pulse) and an inverse
association with the degree of BP reduction from day to night. Cardiovascular risk
was also directly associated with the difference between the observed value of ABP
and that predicted from the office BP. White-coat hypertension versus ambulatory hypertension
and dippers versus nondippers are 2 classifications based on arbitrary operational
risk categories. A blunted or absent BP reduction from day to night, defined with
ABP as a continuous variable or with operational thresholds, was also associated with
a worse outcome regardless of the average value of ABP during the 24 hours. Overall,
these studies indicate that ABP monitoring is particularly valuable to refine cardiovascular
risk stratification in untreated subjects with office hypertension and in those with
resistant hypertension. Intervention studies targeted at ABP are now needed.