Antihypertensive treatment based on conventional or ambulatory blood pressure measurement. A randomized controlled trial. Ambulatory Blood Pressure Monitoring and Treatment of Hypertension Investigators

JAMA. 1997 Oct 1;278(13):1065-72.


Context: Ambulatory blood pressure (ABP) monitoring is used increasingly in clinical practice, but how it affects treatment of blood pressure has not been determined.

Objective: To compare conventional blood pressure (CBP) measurement and ABP measurement in the management of hypertensive patients.

Design: Multicenter, randomized, parallel-group trial.

Setting: Family practices and outpatient clinics at regional and university hospitals.

Participants: A total of 419 patients (> or =18 years), whose untreated diastolic blood pressure (DBP) on CBP measurement averaged 95 mm Hg or higher, randomized to CBP or ABP arms.

Interventions: Antihypertensive drug treatment was adjusted in a stepwise fashion based on either the average daytime (from 10 AM to 8 PM) ambulatory DBP (n=213) or the average of 3 sitting DBP readings (n=206). If the DBP guiding treatment was above (>89 mm Hg), at (80-89 mm Hg), or below (<80 mm Hg) target, 1 physician blinded to the patients' randomization intensified antihypertensive treatment, left it unchanged, or reduced it, respectively.

Main outcome measures: The CBP and ABP levels, intensity of drug treatment, electrocardiographic and echocardiographic left ventricular mass, symptoms reported by questionnaire, and cost.

Results: At the end of the study (median follow-up, 182 days; 5th to 95th percentile interval, 85-258 days), more ABP than CBP patients had stopped antihypertensive drug treatment (26.3% vs 7.3%; P<.001), and fewer ABP patients had progressed to sustained multiple-drug treatment (27.2% vs 42.7%; P<.001). The final CBP and 24-hour ABP averaged 144.1/89.9 mm Hg and 129.4/79.5 mm Hg in the ABP group and 140.3/89.6 mm Hg and 128.0/79.1 mm Hg in the CBP group. Left ventricular mass and reported symptoms were similar in the 2 groups. The potential savings in the ABP group in terms of less intensive drug treatment and fewer physician visits were offset by the costs of ABP monitoring.

Conclusions: Adjustment of antihypertensive treatment based on ABP monitoring instead of CBP measurement led to less intensive drug treatment with preservation of blood pressure control, general well-being, and inhibition of left ventricular enlargement but did not reduce the overall costs of antihypertensive treatment.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Antihypertensive Agents / economics
  • Antihypertensive Agents / therapeutic use*
  • Belgium
  • Blood Pressure Determination / economics
  • Blood Pressure Determination / methods*
  • Blood Pressure Monitoring, Ambulatory / economics
  • Cost-Benefit Analysis
  • Family Practice
  • Female
  • Hospitals, University
  • Humans
  • Hypertension / diagnosis*
  • Hypertension / drug therapy*
  • Hypertrophy, Left Ventricular
  • Male
  • Middle Aged
  • Outpatient Clinics, Hospital
  • Statistics, Nonparametric
  • Survival Analysis


  • Antihypertensive Agents