A comparative meta-analysis of prospective observational studies on masked hypertension and masked uncontrolled hypertension defined by ambulatory and home blood pressure

| INTRODUC TI ONOut-of-office blood pressure (BP) measurement has given the opportunity to detect various hypertension phenotypes. Among them, white coat hypertension (WCH), ie, high clinic and normal out-of-office BP and masked hypertension (MH), that is, normal clinic and high out-of-office BP have been extensively studied in the past years.Their prognostic relevance 1-3 and target organ involvement, 4-6 which is frequently an intermediate stage toward cardiovascular events, have been assessed. Concerning the prognostic impact, it appears still debated in WCH, 1,2 whereas there seems to be unanimous consensus about the adverse prognostic value of MH. 1,3 In the same way, cardiac and vascular involvement look controversial in WCH,4,5 while there is substantial evidence of target organ damage in MH. 6 A meta-analysis in this issue of the Journal of Clinical Hypertension adds to the current knowledge by evaluating pulse wave velocity (PWV), an index of arterial stiffness, in WCH and MH in comparison with normotension and sustained hypertension. 7 Seven studies including 2352 subjects were assessed. Subjects with MH and WCH had significantly higher PWV than normotensive ones (d = 0.96 m/s, 95% CI: 0.49-1.42 for MH and d = 0.85 m/s, 95% CI: 0.48-1.22 for WCH). Moreover, subjects with MH and WCH had lower PWV than sustained hypertensive ones (d = −0.70 m/s, 95% CI: −0.87 to −0.54 for MH and d = −0.75 m/s, 95% CI: −1.52 to 0.02 for WCH). No significant difference between MH and WCH was observed (d = 0.06 m/s, 95% CI −1.04 to 1.15). Thus, the authors concluded that WCH and MH are not clinically innocent. Looking at BP values of selected studies, in comparison with normotensive subjects, clinic BP and 24-hour BP were higher, respectively, by 23/11 mm Hg and 4/2 mm Hg in subjects with WCH and, respectively, by 8/2 mm Hg and 16/10 mm Hg in those with MH. Measurement of PWV is a simple and noninvasive way to assess arterial stiffness, a manifestation of vascular damage associated with hypertension and aging. 8 Various studies have shown that arterial stiffness independently predicts cardiovascular events and it is now accepted as an intermediate end point. 8 The mechanisms underlying arterial stiffening are not yet completely clear. In the context of long-standing hypertension, it has been suggested that endothelial damage, smooth muscle tone, inflammation, oxidative stress, renin-angiotensin system activity, and extracellular matrix turnover and integrity might be involved in this process. 8 However, beyond the impact of vascular structural changes on PWV, this parameter may also by influenced by intercurrent BP modifications. 9Indeed, a powerful confounder of PWV interpretation may be BP.Increased BP augments the arterial wall tension and adds functional arterial stiffness, that is, vessels become stiffer at higher pressures. 9Therefore, the effect of BP increase should be taken into account during PWV analysis. Subjects with WCH have substantial clinic BP increase, at variance with those with normotension or MH, while m...

Section: Introductionmentioning

confidence: 99%

Pulse wave velocity in white coat and masked hypertension

Pierdomenico

Coccina

Madonna

2020

“…This indicates that out‐of‐office BP measurement during antihypertensive medication or titration to the target BP is also important. In recent studies, masked hypertension and MUCH, regardless of ABPM or HBPM, showed adverse prognoses, and MUCH diagnosed via ABPM is associated with increased sympathetic activities . In a recent study on ABPM, MUCH diagnosed on the basis of nocturnal BP is twofold more prevalent than MUCH diagnosed on the basis of daytime BP .…”

Section: Discussionmentioning

confidence: 99%

“…ABPM could be useful for demonstrating BP variabilities . For these reasons, a consensus document from Asian experts was recently published, and more active adoption of ABPM in clinical practice is expected in the future …”

Section: Introductionmentioning

confidence: 99%

Current status of ambulatory blood pressure monitoring in Asian countries: A report from the HOPE Asia Network

Shin

Kario

Chia

et al. 2019

Ambulatory blood pressure monitoring (ABPM) can measure 24-hour blood pressure (BP), including nocturnal BP and diurnal variations. This feature of ABPM could be of value in Asian populations for preventing cardiovascular events. However, no study | 385 SHIN et al. ACK N OWLED G M ENTWe would like to thank Editage (www.edita ge.co.kr) for English language editing. CO N FLI C T O F I NTE R E S TJ Shin has received honoraria and sponsorship to attend seminars from Daiichi Sankyo, Takeda, Menarini, MSD, Bristol-Myers Squibb, and Sanofi. Kario K received research grant from A &D Co.; Omron Healthcare Co.; Roche Diagnostics KK; MSD KK; Astellas Pharma Inc; Otsuka Holdings Co.; Otsuka Pharmaceutical Co.; Sanofi KK; Shionogi & Co.; Sanwa Kagaku Kenkyusho Co.; Daiichi Sankyo Co.; Sumitomo Dainippon Pharma Co.; Takeda Pharmaceutical Co.; Mitsubishi Tanabe Pharma Co.; Teijin Pharma; Boehringer Ingelheim Japan Inc; Pfizer Japan Inc; Fukuda Denshi Co. S Siddique has received honoraria from Bayer, GlaxoSmithKline, Pfizer, ICI, and Servier; and travel, accommodation and conference registration support from Atco Pharmaceutical, Highnoon Laboratories, Horizon

“…Home blood pressure monitoring may play a crucial role in patients with a clinic BP in the range of 130‐139/85‐89 mm Hg or 140‐159/90‐99 mm Hg. In the former case, HBPM may help identify those with masked hypertension, which confers high cardiovascular risk . In the latter case, HBPM may help identify those with white‐coat hypertension, which has a high prevalence and is often treated, but there is little evidence of benefit from antihypertensive therapy in low‐risk patients …”

Section: Positioning Of Hbpm In the 2018 Chinese Hypertension Guidelinesmentioning

confidence: 99%

Asian management of hypertension: Current status, home blood pressure, and specific concerns in China

Guo

Zhang

Wang

2019