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Rationale: Ambulatory blood pressure measurement (ABPM) is commonly used in clinical practice, whereas its added value to the management of hypertension is not definitely documented., Objective: The OCTAVE II study was launched in 1991 to explore the prognostic value of ABPM, compared to that of the gold standard, the clinical blood pressure measurement., Methods: Two hundred and six French cardiologists recruited 3569 participants over 18 years of age, provided they deemed ABPM was useful (mean age of 56 years, 52% of men, 65% already treated by antihypertensive drugs). The prognostic value of various blood pressure measurements, systolic or diastolic, clinical or ambulatory (diurnal, nocturnal or during 24 hours), has been assessed in multivariate models adjusted on the baseline characteristics associated with risk. The outcome was the occurrence of a major cardiovascular event, including stroke, myocardial infarction and cardiovascular death., Results: After an average follow-up of five years, cardiovascular morbidity was known for 85% of the participants, and their vital status for 91%. On the whole population, the best prognostic indicators were systolic blood pressure compared with diastolic, ABPM compared with clinical blood pressure measurements, and nocturnal ABPM compared with diurnal ABPM. In the untreated participants at baseline, cardiovascular risk regularly increased among the four groups: normotensives, white-coat hypertensives, dippers, non-dippers. Between the extreme categories, the cardiovascular event rate was multiplied by 6.5., Conclusion: In this French population, ABPM and most of all its nocturnal component, was better correlated with cardiovascular prognosis. It remains to assess: 1) the general value of our findings, 2) the respective values of self blood pressure measurement versus ABPM, and 3) whether ABPM allows a better risk prevention.

The diagnosis of "white coat" hypertension, the measurement of indices of 24 hour variability of the blood pressure and increased accuracy of blood pressure estimation are some of the advantages of ambulatory blood pressure monitoring. They are part of the reason why the method has been adopted by ambulatory blood pressure monitoring is really useful in the treatment of hypertension is fragile: although the correlation with target organ complications seems better than with conventional blood pressure measurement, it remains to be shown that this information helps to predict and then improve the prognosis of hypertension. With respect to this first stage of demonstration of the added prognostic value attributable to ambulatory blood pressure monitoring, several studies have been undertaken, one of which is OCTAVE II. The goals were to analyse the predictive values of the indices obtained by ambulatory blood pressure monitoring in terms of cardiovascular morbidity and mortality after having described the correlations between these indices and the characteristics of individual patients. Two hundred and sixty six cardiologists, members of the French College of Cardiology, included 3,569 patients in whom an indication for ambulatory blood pressure monitoring had been retained, over a period of 10 months in 1991. These patients were 56.4 year old on average, with 52.6% men, hypertensive or not. The 5 year follow-up should end at the beginning of 1997.