Key Points
- To determine whether home and ambulatory blood pressure monitoring provide incremental predictive value over standard office blood pressure for changes in cardiovascular biomarkers during antihypertensive therapy.
- Assessed 252 hypertensive patients (mean age: 68 years; 41% men) before and after 6 months of antihypertensive therapy with candesartan with or without thiazide-diuretics.
- Measured office blood pressure, home blood pressure, 24-hour ambulatory blood pressure, and cardiovascular biomarkers, specifically urinary albumin excretion (UAE) and brain natriuretic peptide (BNP).
- Home and night-time systolic blood pressure (SBP) reductions independently predicted UAE improvements beyond office SBP (both P < 0.05), with patients reducing office, home, and night-time SBP (n = 122) experiencing greater UAE reductions than those who did not (-52.6% vs. -32.5%; P = 0.001).
- Night-time SBP reduction independently predicted BNP improvements beyond office measurements (P < 0.05), and patients achieving both office and night-time SBP reductions (n = 134) showed significant BNP declines compared with non-achievers (-12.9% vs. +12.8%; P < 0.05).
- Across the cohort, office, home, daytime, and night-time blood pressure along with UAE decreased significantly (all P < 0.01), whereas BNP reductions were observed only in patients receiving diuretic co-treatment (P = 0.003).
Structured PICO
Do changes in home and ambulatory blood pressure predict changes in cardiovascular biomarkers during antihypertensive treatment in hypertensive patients?
PPopulation252 hypertensive patients, mean age 68 years, 41% men
IInterventionCandesartan (± thiazide-diuretics) for 6 months
OOutcomeChanges in cardiovascular biomarkers (urinary albumin excretion (UAE) and brain natriuretic peptide (BNP))surrogate
Home and ambulatory blood pressure monitoring, particularly night-time systolic blood pressure, provide additional prognostic value beyond office blood pressure for predicting biomarker improvements during antihypertensive therapy.