To determine the prognostic significance of ambulatory blood pressure, we prospectively followed for up to 7.5 years (mean, 3.2) 1187 subjects with essential hypertension and 205 healthy normotensive control subjects who had baseline off-therapy 24-hour noninvasive ambulatory blood pressure monitoring. Prevalence of white coat hypertension, defined by an average daytime ambulatory blood pressure lower than 131/86 mm Hg in women and 136/87 mm Hg in men in clinically hypertensive subjects, was 19.2%. Cardiovascular morbidity, expressed as the number of combined fatal and nonfatal cardiovascular events per 100 patient-years, was 0.47 in the normotensive group, 0.49 in the white coat hypertension group, 1.79 in dippers with ambulatory hypertension, and 4.99 in nondippers with ambulatory hypertension. After adjustment for traditional risk markers for cardiovascular disease, morbidity did not differ between the normotensive and white coat hypertension groups (P = .83). Compared with the white coat hypertension group, cardiovascular morbidity increased in ambulatory hypertension in dippers (relative risk, 3.70; 95% confidence interval, 1.13 to 12.5), with a further increase of morbidity in nondippers (relative risk, 6.26; 95% confidence interval, 1.92 to 20.32). After adjustment for age, sex, diabetes, and echocardiographic left ventricular hypertrophy (relative risk versus subjects with normal left ventricular mass, 1.82; 95% confidence interval, 1.02 to 3.22), cardiovascular morbidity in ambulatory hypertension was higher (P = .0002) in nondippers than in dippers in women (relative risk, 6.79; 95% confidence interval, 2.45 to 18.82) but not in men (P = .91). Our findings suggest that ambulatory blood pressures stratifies cardiovascular risk in essential hypertension independent of clinic blood pressure and other traditional risk markers including echocardiographic left ventricular hypertrophy.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of circadian blood pressure (BP) changes on the echocardiographic parameters of left ventricular (LV) hypertrophy were investigated in 235 consecutive subjects (137 unselected untreated patients with essential hypertension and 98 healthy normotensive subjects) who underwent 24-hour noninvasive ambulatory blood pressure monitoring (ABPM) and cross-sectional and M-mode echocardiography. In the hypertensive group, LV mass index correlated with nighttime (8:00 PM to 6:00 AM) systolic (r = 0.51) and diastolic (r = 0.35) blood pressure more closely than with daytime (6:00 AM to 8:00 PM) systolic (r = 0.38) and diastolic (r = 0.20) BP, or with casual systolic (r = 0.33) and diastolic (r = 0.27) BP. Hypertensive patients were divided into two groups by presence (group 1) and absence (group 2) of a reduction of both systolic and diastolic BP during the night by an average of more than 10% of the daytime pressure. Casual BP, ambulatory daytime systolic and diastolic BP, sex, body surface area, duration of hypertension, prevalence of diabetes, quantity of sleep during monitoring, funduscopic changes, and serum creatinine did not differ between the two groups. LV mass index, after adjustment for the age, the sex, the height, and the daytime BP differences between the two groups (analysis of covariance) was 82.4 g/m2 in the normotensive patient group, 83.5 g/m2 in hypertensive patients of group 1 and 98.3 g/m2 in hypertensive patients of group 2 (normotensive patients vs. group 1, p = NS; group 1 vs. group 2, p = 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)

Abstract-The question of serum uric acid as an independent risk factor in subjects with essential hypertension remains controversial. For up to 12 years (mean, 4.0) we followed 1720 subjects with essential hypertension. At entry, all subjects were untreated and all were carefully screened for absence of cardiovascular disease, renal disease, cancer, and other important disease. Outcome measures included total cardiovascular events, fatal cardiovascular events, and all-cause mortality. Key Words: uric acid Ⅲ blood pressure Ⅲ cardiovascular disease Ⅲ hypertension, essential Ⅲ blood pressure monitoring Ⅲ hypertrophy, left ventricular S everal cohort studies conducted over the past 5 decades showed a link between serum uric acid (SUA) and subsequent cardiovascular (CV) disease. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] However, in some of these studies such association did not remain significant after adjustment for concomitant risk factors for CV disease 2,4,5,12,15 or it was detected only in women. 6,8,10 Thus, the role of SUA as an independent risk marker remains controversial. 16 An increase in SUA might be simply a marker of obesity, hyperinsulinemia and glucose intolerance, 17,18 hypertension, 5 hyperlipidemia 19 and renal disease. 20,21 The assessment of the independent prognostic value of SUA is clinically relevant in the specific setting of essential hypertension, in which hyperuricemia is frequent 22 and cardiovascular risk stratification is of utmost importance. In a recent cohort study in subjects with hypertension, 14 the association between SUA and future CV events remained significant after adjustment for concomitant diuretic therapy, previous CV events, and other risk factors including office blood pressure (BP). In contrast, pretreatment SUA was not an independent predictor of CV events in the setting of the European Working Party on High Blood Pressure in the Elderly trial. 23 Because of the discrepancy between these findings, we analyzed the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) database to clarify the independent prognostic value of SUA in a large cohort of initially untreated and apparently healthy subjects with essential hypertension. Methods PIUMA StudyThe design of the PIUMA study has been reported previously. 24,25 Office BP had to be Ն140 mm Hg systolic and/or Ն90 mm Hg diastolic on Ն3 visits, and all of the subjects fulfilled the following inclusion criteria: no previous antihypertensive treatment or treat-

In essential hypertension, a reduction in LV mass during treatment is a favorable prognostic marker that predicts a lesser risk for subsequent cardiovascular morbid events. Such an association is independent of baseline LV mass, baseline clinic and ambulatory BP, and degree of BP reduction.

Abstract-Diabetes may develop in nondiabetic hypertensive subjects during treatment, but the long-term cardiovascular implications of this phenomenon are not clear. We determined the prognostic value of new diabetes in hypertensive subjects. In a long-term cohort study, 795 initially untreated hypertensive subjects, 6.5% of whom with type 2 diabetes, underwent diagnostic procedures including 24-hour ambulatory blood pressure (BP) monitoring and electrocardiography (ECG). Procedures were repeated after a median of 3.1 years in the absence of cardiovascular events. Key Words: hypertension Ⅲ echocardiography Ⅲ hypertrophy Ⅲ blood pressure Ⅲ epidemiology Ⅲ diuretics T he coexistence of hypertension and diabetes is frequent. 1 Type 2 diabetes accounts for Ͼ90% of these cases 2 and cardiovascular risk is markedly increased when hypertension and diabetes coexist. [3][4][5] Despite the evidence of the excess risk associated with the coexistence of hypertension and type 2 diabetes, very limited information exists on the prognostic significance of new diabetes in treated hypertensive subjects. The issue is clinically relevant because widely used antihypertensive agents such as thiazide diuretics and ␤-blockers may increase blood glucose. 6 -8 Some intervention trials showed a lesser incidence of diabetes in hypertensive subjects treated with drugs different from diuretics and ␤-blockers. 9 -12 In this study, we investigated the prognostic value of new type 2 diabetes in a cohort of hypertensive subjects without previous cardiovascular events who repeated some diagnostic procedures before and during treatment. After the follow-up study, subjects continued to be followed-up for detection of major cardiovascular events. Nondiabetic subjects who developed diabetes during treatment and those with established diabetes at entry were compared in their subsequent incidence of cardiovascular events with the nondiabetic subjects who remained free of diabetes. MethodsThe Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study [13][14][15] is an observational registry of morbidity and mortality in initially untreated subjects with essential hypertension. The study was initiated on June 1986. Entry criteria included an office blood pressure (BP) Ն140 mm Hg systolic and/or Ն90 mm Hg diastolic on at least 3 visits and absence of secondary causes of hypertension, previous cardiovascular disease, and lifethreatening conditions. BP was measured by a physician with a mercury sphygmomanometer, with subjects sitting and relaxed for at least 10 minutes. Three measurements were averaged for analysis. Systolic and diastolic BPs were identified by Korotkoff phases I and V. Standard 12-lead ECG was recorded at 25 mm/s and 1 mV/cm calibration. Subjects with complete right or left bundle branch block, previous myocardial infarction, Wolff-Parkinson-White syndrome, and atrial fibrillation were excluded. None of the subjects was being treated with digitalis. Diagnosis of left ventricular (LV) hypertrophy by electrocardiography was made ...