Practice vs ambulatory blood pressure measurement under treatment with ramipril (PLUR Study): a randomised, prospective long-term study to evaluate the benefits of ABPM in patients on antihypertensive treatment

Abstract

The usefulness of ambulatory blood pressure monitoring (ABPM) vs casual blood pressure measurement in the physicians practice (PM) for the routine management of patients with hypertension concerning total mortality and morbidity has been compared in a prospective, randomised, open multicentre study with a 5-year follow-up. The study was performed in general practitioners offices in Germany from 1991 to 1997. A total of 1298 patients with essential hypertension were included. Cardio- and cerebrovascular events, total mortality/morbidity and drug-saving effects in hypertensives treated according to two different methods of blood pressure measurement were the primary and secondary endpoints of the study. A total of 239 patients from group 1 (ABPM, n = 651), and 208 from group 2 (PM, n = 647) prematurely discontinued the study. The reason for discontinuation in 55 of these patients (20 from group 1 and 35 from group 2) was that they reached the main endpoint (total mortality/morbidity and cardio- and cerebrovascular events) of the study. The difference was statistically significant (P = 0.037) in favour of group 1. Cardio- and cerebrovascular events also occurred in a lower number of patients (n = 14) in group 1, as compared to group 2 (n = 24). The difference however was not significant (P = 0.097). A difference in a direct drug-saving effect could not be observed between the two groups but 22% of the initially screened patients were detected with the ABPM to have white coat hypertension and thus these patients did not receive antihypertensive treatment.