Assessment of self-monitoring of blood pressure in the diagnosis of isolated clinic hypertension

Background. There are no studies assessing cardiovascular morbidity/mortality in patients with isolated clinical hypertension (ICH) with self-blood pressure monitoring (SBPM). Objectives. To determine the value of SBPM in the diagnosis of ICH. Methods. Cohort study. New hypertensive and normotensive patients 15-75 years, without cardiovascular events history. Variables. Oriented anamnesis hypertension; blood pressure measurements (BP): clinical BP, SBPM and ambulatory BP monitoring (ABPM); evaluation of target organ damage (TOD), electrocardiogram; retinography and microalbuminuria (MA). Results. One hundred and thirty-five patients, 95 hypertensive (62.1% males; mean age 59.08 +/- 16.8 years), 40 normotensive (37.5% males; mean age 56.32 +/- 10.22 years). BP measurements (mmHg) in normotensives vs hypertensives: clinical BP, 125.36/76.74 vs 149.81/87.86 mmHg (p < 0.0001) and SBPM, 114.90/69.96 vs 142.06/86.31 (p < 0.0001). Twenty-four-hourABPM: 135.41/81.74. Prevalence of TOD in hypertensive: 23.10% left ventricular hypertrophy (LVH), 8.42% haemorrhage or exudates, 3.15% MA; 30.53% of hypertensives had ICH. The BP measurements in ICH vs sustained hypertension (SH): clinic BP, 149.88/86.34 vs 152.51/89.55 (p > 0.10); SBPM: 147.895/88.95 vs 128.17/79 (p < 0.0001) and ABPM, 141.72/88.22 vs 131.66/80 (p = 0.053 for systolic). TOD in SH vs ICH: LVH, 24.6% vs 19.2% (p = 0.814); exudates or haemorrhages, 7.7% vs 9.8% (p = 0.580). The risk of an occurrence of any TOD in ICH patients is lower for 125/80 (OR = 2.5). Conclusions. VAMPAHICA will provide information about value of SBPM in the diagnosis of ICH. Advanced retinopathy is relative frequent in ICH patients. If TOD is accepted as a surrogate endpoint, the diagnostic values of ICH will be probably decreased.