Objective:To identify the prevalence and clinical characteristics of the different hypertension subtypes according to home blood pressure (BP) control in treated hypertensive patients.Design and method:This study was conducted in Siriraj hospital, Mahidol University, Thailand during 2019 to 2020. We included treated hypertensive patients with at least 1 antihypertensive medications and had self-home BP measurement. Hypertension subtypes were normotension (NT) (all home BPs were less than 135/85 mmHg), isolated morning hypertension (MHT)(morning BPs were only at least 135/85 mmHg), isolated evening hypertension (EHT)(evening BPs were only at least 135/85 mmHg) and sustained uncontrolled hypertension (SHT)(all home BPs were at least 135/85 mmHg). We analyzed the clinical data to evaluate blood pressure control rate and identify the associated clinical factors in the other groups.Results:Our study included 1,435 participants. The prevalence of home BP control was 55.82%, 12.61%, 7.32%, and 24.25% in NT, MHT, EHT, and SHT, respectively. Overall mean age was 63 years. There were 39.58% men. SHT group had significantly the highest body mass index, proportions of alcohol drinking and evening administration of antihypertensive medications. The participants in EHT group used the highest number of antihypertensive medication classes and chronic kidney disease was most found in this group. The multivariable analysis showed the significant association of history of CVD with MHT (OR 2.93, 95%CI (1.46 to 5.85)). The albuminuria of at least 300 mg/g was the significant associated factor of EHT (OR 3.05, 95%CI (1.23 to 7.57)) and SHT (OR 2.20, 95%CI (1.14 to 4.27)). Aging (OR 0.98, 95%CI (0.96 to 0.99)), use of thiazide diuretics (OR 3.38, 95%CI (1.03 to 11.11)), sprironolactone (OR 5.68, 95%CI (1.38 to 23.33)) and peripheral alpha1 blockers (OR 3.90, 95%CI (1.16 to 13.11)) were also strongly associated with SHT.Conclusions:BP control rate was fair. There were different clinical characteristics and independent associated factors in each subtypes.

Quality and quantity of home blood pressure (BP) control are important for optimizing hypertensive treatment. The prevalence and associated clinical characteristics of the different home blood pressure phenotypes in treated hypertensive patients were not elucidated. This study was conducted in Siriraj Hospital, Thailand from 2019 to 2020. We included treated hypertensive patients with ≥1 antihypertensive drug and had self-home BP measurement data. Both traditional (office BP < 140/90 mmHg and home BP < 130/80 mmHg) and new BP targets (office and home BP < 130/80 mmHg) were used for the classification of BP phenotypes. Home BP phenotypes consisted of controlled hypertension (all home BPs achieved home BP targets), isolated uncontrolled morning hypertension (MoHT) (only morning BP was above home BP targets), isolated uncontrolled evening hypertension (EHT) (only evening BP was above home BP targets), and combined morning-evening uncontrolled hypertension (MoEHT) (all home BPs were above home BP targets). Our study included 1,406 patients. The total mean age was 62.94 ± 13.97 years. There were 39.40% men. The prevalence of each home BP phenotype (by traditional BP target) was 55.76%, 12.66%, 7.40%, and 24.18% in controlled (home) hypertension, MoHT, EHT, and MoEHT, respectively. Classical BP control status was 35.21% well-controlled hypertension, 30.01% white-coat uncontrolled hypertension, 9.74% masked uncontrolled hypertension, and 25.04% sustained uncontrolled hypertension. The multivariable analysis showed the significantly associated factor of MoHT was the presence of previous cardiovascular disease (adjusted OR 5.54, 95% CI (2.02–15.22); p value = 0.001). Taking once-daily long-acting antihypertensive drugs in the morning were significantly associated with both EHT (adjusted OR 0.20, 95% CI (0.05–0.82); p value = 0.025) and MoEHT (adjusted OR 0.20, 95% CI (0.04–1.00); p value = 0.049). These results were consistent in groups classified by new home BP target <130/80 mmHg.

Objective: To compare blood pressure (BP) and heart rate measured by attended and unattended automated office blood pressure measurement (AOBPM) versus home blood pressure measurement (HBPM) and the effect of unattended AOBPM on the classification of BP phenotypes. Materials and Methods: The cross-sectional study was conducted at the outpatient department in Siriraj Hospital, Thailand. All participants measured their office BP using attended and unattended techniques in random order and recorded home BP twice a day for consecutive 7 days. The agreement between office BP from both AOBPM methods and that from HBPM was analyzed using the Bland-Altman plot. The change in the proportion of each BP phenotype was also analyzed. Results: We included 114 participants. The mean age was 57.96 + 15.07 years. The average BP from attended AOBPM, unattended AOBPM, and HBPM were 150.52 + 16.12/81.77 + 11.04, 139.68 + 13.80/78.55 + 11.71, and 126.91 + 9.80/76.40 + 8.37 mmHg, respectively. The BP and heart rate measured by these techniques were significantly different (p-value of <0.001). Bland-Altman analysis showed the biases of attended and unattended SBP versus home SBP were 23.61 and 12.77 mmHg, respectively. Unattended AOBPM significantly decreased the numbers of patients classified as white-coat and sustained hypertension regardless of BP thresholds (p-value of <0.001 for both groups). Conclusion: Unattended AOBPM significantly minimizes the white-coat effect in real-life clinical practice and may help physicians avoid overdiagnosis of hypertension. Nevertheless, it does not replace HBPM.