Prognostic value of in-hospital 24-hour blood pressure monitoring in patients with arterial hypertension

Aim. To assess the prognostic value of in-hospital 24-hour blood pressure monitoring (BPM) data in patients with arterial hypertension (AH) and other cardiovascular diseases (CVD) within the hospital registry of a multidisciplinary medical center.

Material and methods. This study was conducted as part of the REKVAZA-CLINICA NMIC TPM hospital registry. The final analysis included 358 patients with a mean age at hospitalization of 72.9±12.0 years (median 74.0 [28.7; 97.6] years). Over a mean prospective follow-up period of 9.4±2.3 years (median 10.2 [0.4; 11.5] years), the primary endpoint (PE; all-cause mortality) was recorded in 77 (21.5%) patients. The secondary composite endpoint (SCE) — composing non-fatal acute myocardial infarction and/or non-fatal acute cerebrovascular accident and/or pulmonary embolism and/or relevant surgical interventions and/or hospitalization for concomitant CVD — was identified in 160 (44.7%) patients.

Results. Multivariate analysis in the patient group aged <75 years (n=197) showed that the risk of PE was associated with the presence of concomitant CVD (HR=3.25; 95% CI=1.14-9.22; p=0.027), higher average real variability of systolic BP (HR=1.19; 95% CI=1.01-1.41; p=0.038), and higher mean 24-h pulse pressure (PP) (HR=1.05; 95% CI=1.02-1.09; p=0.001). In the group of patients aged ≥75 years (n=161), PE was associated only with age (HR=1.17; 95% CI=1.12-1.23; p<0.001). In the overall patient cohort (n=358), PE was associated with the riser BP pattern (HR=3.93; 95% CI=1.44-10.73; p=0.008). The SCE was associated with the presence of concomitant CVD (HR=1.88; 95% CI=1.35-2.62; p<0.001) and higher mean daytime PP (HR=1.14; 95% CI=1.08-1.20; p<0.001).

Conclusion. In patients with AH, 24-h BPM parameters obtained in a hospital setting retain their prognostic value, despite the significant impact of cardiovascular comorbidity and age on outcomes.

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