ArticlesBlood-pressure control in the hypertensive population
Introduction
Epidemic logical studies in the USA and Europe show that patients with well-controlled blood pressure represent a small fraction of the hypertensive population.1, 2, 3, 4, 5, 6 Such findings are believed to be due to poor compliance with long-term antihypertensive therapy.1, 7 However, there is the possibility that the blood-pressure measurements used in these studies cause a stress reaction and a pressor response known as the white-coat effect,8, 9 which lead to a distorted view of blood-pressure control.
We tested this hypothesis on a large number of people by measuring clinic blood pressure as well as blood pressures known to be largely free of the white-coat effect10, 11—ie, home and 24 h ambulatory blood pressure.12
Section snippets
Methods
The data reported in this paper come from the Pressioni Arteriose Monitorate E Loro Association (PAMELA) study, which was done to gather information on normal values of ambulatory and home blood pressures. The methodological aspects of the PAMELA study have been reported in detail elsewhere.10 Briefly, 2400 individuals aged 25 to 64 years were selected from the population of Monza, Italy. The sample was chosen to be representative of the Monza residents according to the criteria of the WHO
Results
Of the 1651 of individuals who took part in the study (participation rate 69%) 821 were men and 830 were women. The average age was 46·4 (SD 11·2) years. 1042 participants were classified as normotensive, 402 as untreated hypertensives (96 with only a systolic blood pressure rise), and 207 as treated hypertensives. 19% of the treated group were on diuretics, 30% on β-blockers, 9% on calcium antagonists, 14% on angiotensin-converting-enzyme inhibitors, and 28% on other drugs or drug
Discussion
Our study shows that 28% of the overall sample surveyed in Monza were hypertensive.5 The study also shows that clinic systolic and diastolic blood pressures were raised to similar extents in untreated as in treated hypertensive participants. This finding is consistent with poor blood-pressure control observed in treated hypertensive patients in both American and European populations.1, 2, 3, 4, 5, 6 The important new findings, are that compared with the normotensive population, untreated and
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