Big Data and Blood Pressure Control: Insights from the PAMELA and BP-CARE Study Cohorts
Purpose of Review
The paper examines the patterns of BP control achieved in two large scale observational studies, i.e., the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study and the Blood Pressure control rate and CArdiovascular Risk profilE (BP-CARE), carried out in the general population and in treated hypertensive patients, respectively.
It is well known that only a minor fraction among the treated hypertensive patients exhibits a good blood pressure control. However, few study investigated blood pressure control on the basis not only of office, but also home and ambulatory blood pressure measurement, examining its impact on organ damage.
In the whole sample of the PAMELA study, only in about 21.1% of cases treated hypertensive subjects exhibit a well-controlled office BP. Control of systolic blood pressure was rarer than the diastolic one. Control of home and, even more, ambulatory blood pressure was more frequent. Left ventricular mass was not normalized even when blood pressure was adequately controlled. Most subjects of BP-CARE study show high or very high cardiovascular risk, due to concomitant risk factors and organ damage. The percentage of well-treated hypertensive patients is lower when CV risk is higher.
KeywordsBlood pressure control Office blood pressure Home blood pressure Ambulatory blood pressure Organ damage
Compliance with Ethical Standards
Conflict of Interest
Dr. Mancia reports personal fees from Boehringer Ingelheim, Daiichi Sankyo, Ferrer, Medtronic, Menarini, Merck, Novartis, RecordatI, and Servier outside the submitted work. The other authors declare no conflicts of interest relevant to this manuscript.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 4.Charles-Davies MA, Fasanmade AA, Olaniyi JA, Oyewole OE, Owolabi MO, Adebusuyi JR, et al. Metabolic alterations in different stages of hypertension in an apparently healthy Nigerian population. Int J Hypertens. 2013;2013:351357–6. https://doi.org/10.1155/2013/351357.CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Grassi G, Cifkova R, Laurent S, Narkiewicz K, Redon J, Farsang C, et al. Blood pressure control and cardiovascular risk profile in hypertensive patients from central and eastern European countries: results of the BP-CARE study. Eur Heart J. 2011;32(2):218–25. https://doi.org/10.1093/eurheartj/ehq394.CrossRefPubMedGoogle Scholar
- 10.Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 Guidelines for the management of arterial hypertension: the task force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007 Jun;25(6):1105–87.CrossRefPubMedGoogle Scholar
- 17.•• Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159–219. https://doi.org/10.1093/eurheartj/eht151. The latest guidelines for diagnosis and treatmen of hypertension. CrossRefPubMedGoogle Scholar
- 20.• Cuspidi C, Sala C, Casati A, Bombelli M, Grassi G, Mancia G. Clinical and prognostic value of hypertensive cardiac damage in the PAMELA Study. Hypertens Res. 2017;40(4):329–35. https://doi.org/10.1038/hr.2016.153. A paper reviewing the most recent results of the PAMELA study in relation with cardiac hypertrophy. CrossRefPubMedGoogle Scholar
- 21.Mancia G, Carugo S, Grassi G, Lanzarotti A, Schiavina R, Cesana G, et al. Prevalence of left ventricular hypertrophy in hypertensive patients without and with blood pressure control: data from the PAMELA population. Pressioni Arteriose Monitorate E Loro Associazioni. Hypertension. 2002 Mar 1;39(3):744–9.CrossRefPubMedGoogle Scholar
- 23.• Taverny G, Mimouni Y, LeDigarcher A, Chevalier P, Thijs L, Wright JM, et al. Antihypertensive pharmacotherapy for prevention of sudden cardiac death in hypertensive individuals. Cochrane Database Syst Rev. 2016;3:CD011745. https://doi.org/10.1002/14651858.CD011745.pub2. A recently published meta-analysis on sudden death in hypertension. CrossRefPubMedGoogle Scholar
- 25.Mancia G, Zanchetti A, Agabiti-Rosei E, Benemio G, De Cesaris R, Fogari R, et al. Ambulatory blood pressure is superior to clinic blood pressure in predicting treatment-induced regression of left ventricular hypertrophy. SAMPLE Study Group. Study on Ambulatory Monitoring of Blood Pressure and Lisinopril Evaluation. Circulation. 1997;95(6):1464–70.CrossRefPubMedGoogle Scholar
- 28.• Sharman JE, Boutouyrie P, Laurent S. Arterial (aortic) stiffness in patients with resistant hypertension: from assessment to treatment. Curr Hypertens Rep. 2017;19(1):2. https://doi.org/10.1007/s11906-017-0704-7. An updated review on vascular alterations in resistant hypertension. CrossRefPubMedGoogle Scholar