Clinical Correlates of Ambulatory Blood Pressure Phenotypes at a Tertiary Care Hospital in Turkey

Abstract

Background/Aims: Hypertension and its complications are major public health issues worldwide due to their association with high cardiovascular morbidity and mortality. Despite significant progress in health, the prevalence of hypertension is increasing. Ambulatory blood pressure monitoring (ABPM) is becoming increasingly important for the management of hypertension. In this study, we aimed to investigate the clinical and laboratory correlates of ambulatory blood pressure (ABP) phenotypes at a tertiary care hospital in Turkey. Methods: The characteristics of 1053 patients were retrospectively obtained from the hospital database. Hypertension was defined as patients with office blood pressure (BP) ≥140/90 mmHg and/or previously diagnosed hypertension and/or the use of antihypertensive medication. According to the office BP and ABPM results patients were identified namely: (1) sustained normotensive (SNT) patients (both office BP and ABPM were normal), (2) sustained hypertensive (SHT) patients (both office BP and ABPM were high), (3) masked hypertensive (MHT) patients (office BP were normal, but ABPM were high), (4) white coat hypertensive (WCHT) patients (office BP were above limits, but ABPM were normal). Results: A total of 1053 patients were included to the study (female/male: 608/445 and mean age 55 ± 15 years). The mean age of patients with hypertension was significantly higher than without hypertension (p< 0.0001). Hypertension was more frequent in females (p=0.009). The rates of history of diabetes mellitus (DM), hyperlipidemia (HL), and chronic kidney disease (CKD) were higher in patients with hypertension (p< 0.0001). Among patients with hypertension (n=853, 81%), ABPM results showed that 388 (45%) of patients had SHT, 92 (11%) had MHT, and 144 (17%) had WCHT, whereas 229 (27%) had SNT. Patients with MHT were significantly older than patients with SNT (p=0.025). The prevalence of SHT was higher in men than in women, whereas the prevalence of WCHT was higher in women than in men (p< 0.0001). There was no significant difference between 4 groups with regard to body mass index (p=0.142), a history of DM (p=0.189) and smoking status (self-reported) (p=0.306). Patients with SHT had the highest prevalence of history of hypertension, HL and CKD (p< 0.0001). Among patients without hypertension, 26 (13%) of patients had MHT and none of those patients was on antihypertensive treatment. Conclusion: Potential usages of ABPM in Turkey may include screening of high risk individuals who have traditional cardiovascular risk factors. It also provides clinicians valuable information on abnormal ABP phenotypes. Future studies are needed to clarify the risk factors of different ABP phenotypes and to evaluate the role of ABPM on detection and control of hypertension.

Prevalence and clinical correlates of ambulatory blood pressure phenotypes in a Saudi hypertensive population

“…We observed MHT in 32% of our cohort, associated with high‐normal office BP, CKD, older age, and obesity, similar to SHT. While our findings confirm previous studies, 9 they are at odds with the only ME study showing a prevalence of MHT at 11%, associated with older age only 10 . MHT, but not SHT, was also associated with nocturnal HTN and INH.…”

“…The higher prevalence of nocturnal HTN, INH, and non‐dipping 8 compared with others, 3,11 including recent studies from ME, 12 may indicate the Arab population to have a different risk profile than other ethnicities. The low prevalence of WHT in our study is comparable with some 13 but not others, 6 including a study from ME with prevalence of 17% 10 . Recent evidence also suggests that the incremental risk of events with WHT may only be slightly higher than normotension 14 …”

“…The low prevalence of WHT in our study is comparable with some 13 but not others, 6 including a study from ME with prevalence of 17%. 10 Recent evidence also suggests that the incremental risk of events with WHT may only be slightly higher than Our study has certain limitations. It has limited generalizability being single-center study.…”

“…While our findings confirm previous studies, 9 they are at odds with the only ME study showing a prevalence of MHT at 11%, associated with older age only. 10 MHT, but not SHT, was also associated with nocturnal HTN and INH. Although suboptimal prescribing in MUCH is ascribed to many factors, 9 therapeutic inertia may play an important role as these individuals present with high-normal office BP, as observed in this study.…”

Diagnostic performance of clinic and home blood pressure measurements compared with ambulatory blood pressure: a systematic review and meta-analysis

“…Among the studies that reported 2 × 2 data (n = 66,767), 29 studies [ 9 , 11 , 20 – 34 , 40 , 58 – 63 , 66 , 72 – 74 ] used a CBPM cutoff threshold as ≥ 140/90 for diagnosis of HT, while one study [ 19 ] used the threshold of DBP > 95 mmHg and one study did not reported the threshold. The 24-h ABPM had a cut-off of ≥ 130/80 mmHg for 12 studies [ 11 , 26 , 31 – 33 , 58 , 59 , 61 – 63 , 74 ] and daytime ABPM had a cut-off of ≥ 135/85 mmHg for 16 studies [ 20 – 25 , 28 – 30 , 34 , 60 , 65 , 66 , 73 ]. Two [ 27 , 72 ] and one [ 19 ] studies applied daytime ABPM with cut-offs of ≥ 140/85 and DBP ≥ 95 mmHg, respectively (see Additional file 1 : Table 2).…”