Background Multiple epidemiological studies from Europe and Asia have demonstrated increased cardiovascular risks associated with isolated elevation of home blood pressure (BP) or masked hypertension (MH). Previous studies have not addressed cardiovascular outcomes associated with MH and white coat hypertension (WCH) in the general population in the United States. Objectives The goal of this study was to determine hypertensive target organ damage and adverse cardiovascular outcomes associated with WCH (high clinic BP ≥140/90 mm Hg, normal home BP of <135/85 mm Hg), MH (high home BP ≥135/85 mm Hg, normal clinic BP <140/90 mm Hg), and sustained hypertension (SH, high home and clinic BP) in the Dallas Heart Study, a large, multiethnic probability-based population cohort. Methods We evaluated associations between WCH, MH, SH and aortic pulse wave velocity (APWV) by magnetic resonance imaging; urinary albumin to creatinine ratio (UACR); and cystatin C at study baseline. Then, associations between WCH and MH with incident cardiovascular outcomes (coronary heart disease, stroke, atrial fibrillation, heart failure, and cardiovascular death) over a median follow-up period of 9 years were assessed. Results The study cohort comprised 3,027 subjects (50% African Americans). The sample-weighted prevalence of WCH and MH were 3.3% and 17.8%, respectively. Both WCH and MH were independently associated with increased APWV, cystatin C, and UACR. Both WCH and MH were independently associated with higher cardiovascular events compared with the NT group, even after adjustment for traditional cardiovascular risk factors (adjusted HR: 2.09; 95% CI: 1.05 to 4.15 and adjusted HR: 2.03; 95% CI: 1.36 to 3.03, respectively). Conclusions In a multiethnic U.S. population, both WCH and MH were independently associated with increased aortic stiffness, renal injury, and incident cardiovascular events. Because MH is common and associated with an adverse cardiovascular profile, home BP monitoring should be routinely performed among U.S. adults.

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Objective: Investigate blood pressure (BP) outcomes in primary aldosteronism (PA) patients following adrenalectomy or medical therapy in the context of the lower BP target goal and threshold proposed by the 2017 ACC/AHA blood pressure guidelines. Methods: A retrospective study was conducted in patients with confirmed diagnosis of PA who were referred to Hypertension clinic at the University of Texas Southwestern between January 2009 and August 2017. Presence of PA was confirmed using previously recommended cutoff values of urinary aldosterone greater than 12 mcg/2h for the oral salt loading test and serum aldosterone greater than 10 ng/dL after intravenous saline suppression test. Patients were categorized into adrenalectomy or medical therapy groups. The average BP and number of anti-hypertensives were compared between the two groups at each clinic visit. Hypertension cure rate of PA patients undergoing adrenalectomy was compared using the JNC8 threshold BP of 140/90 mmHg versus the 2017 ACC/AHA threshold BP of 130/80 mmHg. Results: Forty-nine patients were found to have PA. Twenty-two patients had an adrenalectomy, twenty-seven patients were started on a mineralocorticoid antagonist. The adrenalectomy subgroup required a fewer number of anti-hypertensives at the last follow-up visit (p=0.0004) compared to the medically treated group. Systolic BP reduced similarly from the baseline visit to the last visit in the adrenalectomy group compared to the medical therapy group (from 151.3 +/- 5.7 to 134.3 +/- 4.5 mmHg vs. 149 +/- 4.1 to 134.7 +/- 4.1 mmHg, p < 0.01 for visit and p=0.5 for group). Thirteen percent (3 of 23) of adrenalectomy patients achieved cure based on the previous JNC8 guidelines, whereas only 8.7% (2 of 23) achieved cure based on the current guidelines. Conclusion: Adrenalectomy is more efficacious than medical management in reducing the number of anti-hypertensives needed for BP control. The percentage of patients who achieved cure following adrenalectomy decreased when defined by the 2017 ACC/AHA guidelines.