Prediction of treatment-induced changes in target-organ damage using changes in clinic, home and ambulatory blood pressure

Cross-sectional studies have shown that ambulatory and home blood pressure (ABP and HBP, respectively) measurements are more closely associated with preclinical organ damage than are office measurements. This study investigated the association between treatment-induced changes in BP assessed by the three methods and the corresponding changes in organ damage. Untreated hypertensives were evaluated with office, ABP and HBP measurements and indices of organ damage (echocardiographic left-ventricular mass index (LVMI), pulse wave velocity (PWV), albuminuria) before and after 12 months of treatment. A total of 116 subjects completed the study (mean age 50.7±10.5 years, 69 men (59%), mean follow-up 13.4±1.4 months). The treatment-induced change in the LVMI was correlated with changes in BP and pulse pressure (PP) assessed by all methods. The change in PWV was correlated with changes in home systolic and ABP and PP and with the change in home diastolic BP. Albuminuria showed no correlations. In linear regression models, changes in home BP and PP had the strongest predictive ability for the change in the LVMI, whereas the change in ABP was the strongest predictor of the change in PWV. The change in office BP had no predictive value. HBP and ABP measurements appear to be superior to office BP measurements and should be considered complementary rather than interchangeable methods for monitoring the effects of antihypertensive treatment on target-organ damage.