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Morning and smooth 24-h ambulatory blood pressure control is not achieved in general practice: results from the SURGE observational study

Parati, Gianfrancoa,b; Bilo, Grzegorza,b; Redon, Josepcon behalf of the SURGE Steering Committee


With regret, the affiliation of Dr. Grzegorz Bilo was incorrect [1].

The correct affiliation is: Grzegorz Bilo - Department of Cardiology, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy

Journal of Hypertension. 32(6):1355, June 2014.

doi: 10.1097/HJH.0b013e32835ca8bf
ORIGINAL PAPERS: Therapeutic aspects

Background: The aim of this large-scale, practice-based observational study [Survey with HBPM and ABPM Under Real clinical conditions in General practice to Evaluate BP control in the early morning (SURGE)] was to ascertain the degree of morning and 24-h ambulatory blood pressure (ABP) control in hypertensive patients.

Methods: Hypertensive patients [with uncontrolled clinic blood pressure (BP) >140/90 mmHg at screening] from nine different countries were included. Ambulatory BP monitoring was performed over 24 h at 15-min intervals during the day and at 20-min intervals during the night. Assessments included morning (0600–1159 h) and daytime ABP control (BP < 135/85 mmHg), and 24-h ABP control, which was set at levels less than 125/80 mmHg (ESH/ESC guidelines) and less than 130/80 mmHg (USA guidelines).

Results: A total of 3312 patients were enrolled [mean clinic BP: 153 ± 17/91 ± 10 mmHg; mean 24-h and morning ABP: 130 ± 15/77 ± 10 mmHg and 134 ± 16/80 ± 11 mmHg, respectively; antihypertensive use: 72.7% (n = 2409)]. Morning and daytime (period of activity) ABP control was observed in 45.2 and 47.4% of treated patients, respectively; 24-h ABP control was only achieved in 34.6% (ESH/ESC guidelines) and 44.7% (USA guidelines) of treated patients. There was ‘poor agreement’ between clinic BP and ABP regarding BP control as shown by a negative (≤0) κ coefficient in treated patients. Clinic BP control (<130/80 mmHg) and morning ABP control (<135/85 mmHg) was observed in 2.3 and 45.1% of diabetic patients, and in 2.4 and 43.6% of patients with left ventricular hypertrophy (LVH). Morning ABP control was 42.3% in patients with high/very high cardiovascular risk.

Conclusions: Clinic BP, morning and 24-h ABP control rates were low in treated hypertensive patients, including those with comorbidities, such as diabetes or LVH.

aDepartment of Health Sciences, University of Milano-Bicocca

bDepartment of Cardiology, St Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy

cClinic, Hospital Clinico, INCLIVA, University of Valencia, and CIBER of Obesity and Nutrition C/006, Institute of Health Carlos III, Spain

Correspondence to Gianfranco Parati MD, Department of Cardiology, S. Luca Hospital, Piazza Brescia 20, 20149, Milan, Italy. Tel: +39 02 61911 2 890; fax: +39 2 61911 2956; e-mail:

Abbreviations: ABP, ambulatory blood pressure; ABPM, ambulatory blood pressure monitoring; ACAMPA, Analysis of the Control of blood pressure using Ambulatory blood pressure monitoring; BP, blood pressure; ESC, European Society of Cardiology; ESH, European Society of Hypertension; JNC VII, The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; LVH, left ventricular hypertrophy; MBPS, morning blood pressure surge; PAMELA, Pressioni Arteriose Monitorate E Loro Associazioni; PRISMA, Prospective, Randomized Investigation of the Safety and efficacy of Micardis vs. Ramirpil Using ABPM; SURGE, Survey with HBPM and ABPM Under Real clinical conditions in General practice to Evaluate BP control in the early morning

Received 24 September, 2011

Revised 27 June, 2012

Accepted 15 November, 2012

© 2013 Lippincott Williams & Wilkins, Inc.