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The Pressioni Arteriose Monitorate E Loro Associazioni, known worldwide as PAMELA Study, was
planned and initiated almost twenty years ago. This research project was designed to collect information
from a sample of the general population geographically located in Monza (a town located in the north-east
of Milan, Italy) and surroundings.
The PAMELA study allowed important new insights to be achieved in the following areas:
I - Initial steps
The study started in 1990 with, as first goal to define the values of normality of blood pressure as selfmeasured at home - home blood pressure - and ambulatory blood pressure - 24-hour blood pressure - as
measured outside the clinic environment. Until then, these normality values had mostly only been based
on measurements collected in subjects referred for hypertension to specialists clinics, thus introducing an
important selection bias.
PAMELA solved this issue for the first time (1), by obtaining several types of blood pressure
measurements, i.e. clinic blood pressure with a mercury sphygmomanometer, home blood pressure with
a semiautomatic oscillometric validated device, and 24-hour blood pressure with an automatic and
validated device. All were taken from a large sample randomly selected from the population of Monza,
stratified only for gender and age ranging from 25 to 74 years.
In addition, study protocol included collection of medical history, echocardiograhic determination of left
ventricular mass as well as metabolic data. Out of 3200 subjects selected, 64% agreed to take part in the
study. This portion of subjects underwent the same measurements 10 years later -participation rate was
approximately 70%-, and were followed from randomisation for 148 months altogether a time during
which all causes of deaths and cardiovascular events were recorded.
Conclusion The results of the PAMELA study as reviewed in this paper confirm the importance of
epidemiological studies which are capable of providing dynamic information on a given disease, its
complications and interactions with other pathological states or risk factors. In the next years new data will
hopefully be collected in the context of a new PAMELA study, whose detailed planning is currently
ongoing.
Notes to editor
Guido Grassi, Giuseppe Mancia
Clinica Medica, Dipartimento di Medicina Clinica e Prevenzione, Ospedale San Gerardo,Monza and
Universit Milano-Bicocca, Milan, Italy.
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blood pressure normality: results from the PAMELA study. J Hypertens 1995;13:1377-1390
2. Mancia G, Sega R, Grassi G, Cesana G, Zanchetti A. Defining ambulatory and home blood
pressurenormality: further considerations based on data from the PAMELA study. J Hypertens
2001;19:995-999
3. Mancia G, Bombelli M, Lanzarotti A, Grassi G, Cesana G, Zanchetti A, Sega R. Systolic vs
diastolic blood pressure control in the hypertensive patients of the PAMELA population. Pressioni
Arteriose Monitorate E Loro Associazioni. Arch Intern Med 2002;162:582-586.
4. Sega R, Trocino G, Lanzarotti A, Carugo S, Cesana G, Schiavina R, Valagussa F, Bombelli M,
Giannattasio C, Zanchetti A, Mancia G. Alterations of Cardiac Structure in Patients With Isolated Office,
Ambulatory, or Home Hypertension: Data From the General Population (Pressione Arteriose Monitorate E
Loro Associazioni [PAMELA] Study). Circulation 2001;104:1385-1392.
5. Mancia G, Facchetti R, Bombelli M, Madotto F, Quarti-Trevano F, Grassi G, Sega R. Increased longterm risk of new-onset diabetes mellitus in white-coat and masked hypertension. J Hypertens
2009;27:1672-1678
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7. Mancia G, Carugo S, Grassi G, Lanzarotti A, Schiavina R, Cesana G, Sega R. Prevalence of left
ventricular hypertrophy in hypertensive patients without and with blood pressure control: data from the
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9. Sega R, Corrao G, Bombelli M, Beltrame L, Facchetti R, Grassi G, Ferrario M, Mancia G. Blood
pressure variability end organ damage in a general population: results from the PAMELA study.
Hypertension 2002;39:710-714
10. Mancia G, Bombelli M, Facchetti R, Madotto F, Corrao G, Quarti-Trevano F, Grassi G, Sega R. Longterm prognostic value of blood pressure variability in the general population. Results of the Pressioni
Arteriose Monitorate E Loro Associazioni Study. Hypertension 2007;49:1265-1270.
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arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of
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Eur Heart J. 2007 Jun;28(12):1462-536. Epub 2007 Jun 11.
The content of this article reflects the personal opinion of the author/s and is not necessarily the official
position of the European Society of Cardiology.