Cardiovascular Risk In White-coat and Sustained Hypertensive Patients

Abstract

We compared cardiovascular outcome between patients with white-coat and sustained hypertension who had previously participated in the Ambulatory Blood Pressure Monitoring and Treatment of Hypertension (APTH) trial. Baseline characteristics, including office and ambulatory blood pressure (BP), were measured during the 2-month run-in period of the APTH trial. During follow-up, information on the occurrence of major cardiovascular events (death, myocardial infarction, stroke and heart failure), achieved office BP and treatment status was obtained. At entry, 326 patients had sustained hypertension (daytime ambulatory BP > or = 140 mmHg systolic and/or > or = 90 mmHg diastolic) and 93 had daytime ambulatory BP below these limits and were classified as white-coat hypertensives. During 2088 patient-years of follow-up (median follow-up 5.3 years), all major cardiovascular events (n = 22) occurred in the patients with sustained hypertension (rate 12.7 per 1000 patient-years, p = 0.02 for between-group difference). Furthermore, multiple Cox regression confirmed that after adjustment for important covariables, daytime ambulatory BP--but not office BP at entry--significantly and independently predicted cardiovascular outcome. After additional adjustment for office BP, daytime ambulatory BP still predicted the occurrence of major cardiovascular events. Although white-coat hypertension was less frequently associated with antihypertensive drug treatment during follow-up, it carried a significantly better prognosis than sustained hypertension.

Night–day blood pressure ratio and dipping pattern as predictors of death and cardiovascular events in hypertension

“…3,4,6 Inclusion and exclusion criteria of the individual studies and results on the prognostic significance of various aspects of ABP have been reported previously. [3][4][5][6][11][12][13][14] The current meta-analysis is based on a total of 3468 hypertensive patients without debilitating illness or major CVD at baseline, such as myocardial infarction, stroke or congestive heart failure (CHF).…”

“…[3][4][5][6][11][12][13][14] The current meta-analysis is based on a total of 3468 hypertensive patients without debilitating illness or major CVD at baseline, such as myocardial infarction, stroke or congestive heart failure (CHF). We included 1108 patients from the Systolic Hypertension in Europe trial, 3 419 patients from the Ambulatory blood pressure Monitoring and Treatment of Hypertension trial, 4 1963 patients from the Office BP (OBP) vs ABP study 5 and 222 patients from a study on X60-year-old patients in one primary care practice. 6 The patient selection process has been described in detail.…”

“…6 The patient selection process has been described in detail. 7 Blood pressure OBP was the average of 2 3 or 3 [4][5][6] BPs measured in the sitting position by the auscultatory technique using the fifth Korotkoff sound for diastolic BP, during the baseline visit closest to the ABPM. ABP was monitored during 24 h, by use of validated devices.…”

“…ABP was monitored during 24 h, by use of validated devices. BP was measured every 15 min 4,6 or at intervals of not more than 30 min 3,5 during daytime and every 30 min 4,6 or at intervals of not more than 60 min 3,5 during the night. In the current analysis daytime ABP was the average BP from 10: 00 hours to 20: 00 hours and night-time ABP was the average BP from midnight to 06: 00 hours, which corresponds well with the actual awake and asleep ABP.…”

“…When daytime and night-time ABP were included in the same models, night-time ABP was superior to daytime ABP for all-cause, 1,2 cardiovascular (CV), cardiac and stroke mortality. 1 In a recent meta-analysis on individual patient data from four prospective studies performed in Europe and coordinated in Belgium, [3][4][5][6] we showed that both daytime and nighttime ABP carry prognostic information for mortality and fatal and non-fatal CV disease (CVD) events but that night-time ABP is in general a better predictor of outcome than daytime ABP. 7 Patients with a history of major CVD were excluded from the analysis to avoid reverse causality.…”