In the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study, clinical, metabolic variables as well as office, home, and ambulatory blood pressure (BP) values were measured contemporaneously at baseline and after a ten-year period of follow-up, which allowed us to assess the value of selective and combined elevation of these BPs in predicting new onset metabolic syndrome (MetS).
The present analysis included 1,182 participants without MetS at baseline, as defined by the APT III criteria. Based on office, 24-hour ambulatory BP and home values, subjects were divided into 4 groups: normal, with coat hypertension (WCH), masked hypertension (MH); and sustained hypertension (SH).
As compared to subjects with in-office and out-of-office BP normality a greater age- and gender-adjusted incidence of new onset Mets was observed in WCH (OR = 2.03, CI:1,21-3.41, p = 0.007), MH (OR = 2.55, CI:1.26–5.17; p = 0.009) and SH (OR = 2.28, CI:1.43–3.99, p = 0.0009) when out-of-office BP was defined by ambulatory criteria. This was not the same when out-of-office BP was based on home criteria, as only the WCH group showed a significant greater OR risk (2.16, CI: 1.28–3.63, p = 0.003).
Our study provides evidence that isolated or combined BP elevations when identified by office/ambulatory measurements, carry an increase in risk of new onset MetS, while classifying the population by combining office/home BPs only WCH is associated with a greater risk of incident MetS. In a clinical perspective, a comprehensive evaluation of BP status based on office/ambulatory measurements may substantially improve the risk stratification of new onset MetS and to activate measures for its prevention
1Department of Medicine and Surgery, University of Milano-Bicocca; Istituto Auxologico Italiano IRCCS, Milan, I, ITALY
2Department of Medicine and Surgery, University of Milano-Bicocca, Milan, ITALY
3Department of Medicine and Surgery, University of Milano-Bicocca, Milan, ITALY
4Charité-University-Medicine Campus Virchow Klinikum, Berlin, Berlin, GERMANY
5Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore Policlinico, Milan, ITALY
6Department of Medicine and Surgery, University of Milano-Bicocca, Milan, ITALY
7Department of Medicine and Surgery, University of Milano-Bicocca, Milan, ITALY