Office, Home and Ambulatory Blood Pressure Control in Patients With High and Very High Cardiovascular Risk – Results From Bp-Proaction Bg

Objective: Current ESH guidelines emphasize out-of-office blood pressure monitoring in patients requiring antihypertensive therapy. Achieving control within the 24-hour period and during home monitoring is of key importance in patients at high (HR) and very high cardiovascular risk (VHR). Design and method: 220 treated with antihypertensive agents’ patients at high or very high risk were included in BP-proAction BG study. All individuals underwent office BP measurements and 24-hour ambulatory blood pressure monitoring consequently followed by 7-day home BP monitoring. Therapy was modified according to office blood pressure values based on methodical standards and treating physicians’ preferences. The protocol was repeated after 3 month of therapy intensification Results: 19% of enrolled patients experienced a cardiovascular event prior to study enrollment, with a mean SCORE 2/SCORE 2 OP of 17.2% among individuals in the primary prevention setting. Despite treatment with an average of 2.7 medications, the majority of patients had uncontrolled blood pressure at the baseline visit - office 93%, home 72%, 24h ABPM 70%, daytime ABPM 63%, nighttime ABPM 69%. After therapy intensification to average 3.4 medications the frequency of uncontrolled hypertension was reduced to 21%, 38%, 34%, 33% and 37% respectively at month 3. The prevalence of masked uncontrolled hypertension among patients with control of office blood pressure was 17% for home masked hypertension, 15% for ambulatory masked hypertension and 10% for dual MH. The rate of uncontrolled hypertension was significantly lower in patients being treated with fix dose combination alone vs free drugs combination. (Table 1) Conclusions: Among patients with high and very high cardiovascular risk, lack of control of out-of-office blood pressure is a common phenomenon, requiring adequate detection and therapeutic management.