Relationship of Office, Home, and Ambulatory Blood Pressure to Blood Glucose and Lipid Variables in the PAMELA Population

Abstract

Abstract-Alterations in blood glucose and cholesterol are more frequently detectable in hypertensive than in normotensive conditions. However, no information exists as to whether this phenomenon involves only office or also home and 24-hour ambulatory blood pressure (ie, when values are representative of daily life). In 2045 subjects enrolled in the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study, we measured home, 24-hour, and office blood pressure. Measurements also included fasting blood glucose and serum total and HDL cholesterol values. Prevalence of diabetes (Ն126 mg/dL or use of antidiabetic drugs), impaired fasting blood glucose (Ն110 to Ͻ126 mg/dL), and hypercholesterolemia (serum total cholesterol Ն240 mg/dL or 200 mg/dL) increased progressively from "optimal" to "normal," " high-normal," and "elevated" office systolic or diastolic blood pressure. Fasting blood glucose and total serum cholesterol also increased progressively from the first to the fourth group, with HDL cholesterol values showing a concomitant progressive decrease. This was also the case for quartiles of office, home, and 24-hour blood pressure.In the whole population, there was a positive correlation between serum cholesterol or blood glucose and all blood pressure values (P always Ͻ0.0001), with a much smaller and less consistent relationship with heart rate. 1,5,7,12 suggesting that the relationship between blood pressure and metabolic alterations may have a continuous rather than a threshold-related nature.We thought that the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study 13 could provide relevant information on this issue because: (1) blood pressure, total serum cholesterol, and blood glucose were assessed in a sample representative of the general population; and (2) blood pressure measurements were obtained not only in the office but at home and during the 24 hours (ie, under conditions devoid of biological artifacts such as the white coat effect and representative of daily life values). 14 -15 MethodsThe methodology used in the PAMELA study has been reported in detail previously. 13 Briefly, 3200 individuals were selected randomly from the residents of Monza (a town in the northeast part of the Milan province) to be representative of the town population for gender, age decades (25 to 74 years), and socioeconomic characteristics, according to the criteria used in the World Health Organization Monitoring Diseases (WHO-MONICA) project conducted in the same geographic area. 16 -17 The overall participation rate was 64% consistently in each age-gender stratum. The demographic characteristics of nonparticipants were similar to those of participants. This was also the case for cardiovascular risk factors on the basis of information collected via telephone interviews. Entry DataParticipants were invited to come to the outpatient clinic of the local hospital (San Gerardo) in the morning of a working day (Monday through Friday) where several data were collected. Relevant to the present study are: (1) ...

Comparison of Microalbuminuria in 2 Blood Pressure Categories of Prehypertensive Subjects

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Clinical implications of white-coat effect among patients attending at a lipid clinic

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Effects of serum uric acid on blood-pressure lowering treatment

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