Introduction: Preliminary evidence suggests the superiority of office aortic (a) blood pressure (BP) over brachial (b) in the management of arterial hypertension. The 24-hour ambulatory blood pressure monitoring (ABPM) is regarded as the optimal method for assessing cardiovascular (CV) risk. The non-invasive 24-hour aABPM is now feasible with validated operator independent brachial cuff-based oscillometric devices.

Objective: To examine whether aABPM is superior to bABPM for the ealry detection of cardiac and/or arterial damage in hypertensives.

Design and method: The SAFAR study is an ongoing cross-sectional observational study assessing heart function and structure, arterial (carotid, femoral and lower limb) atheromatosis, arterial stiffness (carotid and aortic), arterial hypertrophy (carotid) and retinal microcirculation in individuals’ refferred for BP evaluation.

Results: In consecutive individuals referred for BP evaluation the aABPM had greater ability than bABPM to detect both left ventricular hypertrophy and diastolic dysfunction (n=229, area under the curve: 0.74 versus 0.69, p=0.004 and 0.69 versus 0.63, p=0.001, by c-statistics respectively), common carotid intimal-medial thickness greater than 0.9 mm (n=490, 0.69 versus 0.62, p=0.009), but not narrowed retinal arteries assessed by central retinal arteriolar equivalent in fundus photography, (n=402 eyes, 0.62 versus 0.61, p=ns).

Conclusions: aABPM is able to detect better than bABPM an early local damage at the heart and the nearby conduit arteries, but not at the distal retinal microcirculation.