Risk prediction by ambulatory blood pressure monitoring in non-diabetic and diabetic patients: better than office measurements

Extract

This editorial refers to ‘Office measurement vs. ambulatory blood pressure monitoring: associations with mortality in patients with or without diabetes’, by M. Böhm et al., https://doi.org/10.1093/eurheartj/ehae337.

This issue of the European Heart Journal includes a study by Bohm and colleagues¹ based on a large collection of ambulatory and office systolic blood pressure (SBP) data from Spanish clinical practice, which focuses on the relationship of ambulatory BP with cardiovascular and all-cause mortality in diabetic patients.¹ The study shows firstly that, in diabetic patients, the risk of cardiovascular and all-cause mortality increases progressively and steeply from a 24 h mean SBP of <120 mmHg to an SBP > −160 mmHg, i.e. the SBP range in which most individuals from the population lay. Secondly, the authors show that at each ambulatory SBP level, the risk is clearly greater in diabetic than in non-diabetic patients. Thirdly, the steep increase in mortality with a 24-h SBP increase can also be seen when mean day-time and night-time SBP values are analysed separately. Fourthly it is shown that diabetes further increases the risk of mortality in phenotypes that can be identified by joint office and ambulatory BP measurements, such as true normotension (normal 24-h and office BP), masked hypertension (normal office and high 24-h BP), and sustained hypertension (high office and 24 h BP), with an apparent preservation of a greater mortality risk in the latter two hypertensive phenotypes compared with the normotensive phenotype. These findings considerably extend previous information on the epidemiological importance of ambulatory BP to stratify cardiovascular risk in diabetes, an issue which had in the past lagged behind that obtained in the general or non-diabetic population. The very large dimension of the database (∼60 000 patients, of whom ∼11 000 had diabetes) gives strength to the results.