How Often Do Office Blood Pressure Measurements Fail to Identify True Hypertension?: An Exploration of White-Coat Normotension

Selenta, C.; Hogan, Brenda E.; Linden, Wolfgang

doi:10.1001/archfami.9.6.533

Cited by 90 publications

(94 citation statements)

References 26 publications

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“…A study of 319 subjects that applied a battery of tests for anxiety, depression, stress, disappointment, hostility and social support showed no difference between masked hypertensives and normotensives. 14 The MMPI-2 type-A scale questionnaire that was used in this study to evaluate the personality type has been proven to predict coronary heart disease incidence in a cohort of disease-free individuals. 18 The results showed masked hypertensives to be less of type-A personality, meaning that they were less hard-driving, fast-moving and work-oriented compared with white coat or sustained hypertensives that were more impatient and irritable.…”

Section: Discussionmentioning

confidence: 99%

“…Yet, scant attention has been placed on psychological parameters, such as daily stress, hostility, anger, depression and social support. 14 The aim of this study was to investigate potential characteristics related with the occurrence of MH and to compare the cardiovascular status of these subjects with white coat and sustained hypertensives.…”

Section: Introductionmentioning

confidence: 99%

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Masked, white coat and sustained hypertension: comparison of target organ damage and psychometric parameters

Konstantopoulou

Papargyriou

et al. 2009

J Hum Hypertens

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Masked hypertension is defined as low clinic and elevated out-of-clinic pressure (blood pressure, BP) assessed either by patients at home or by ambulatory monitoring. This study compared the cardiovascular status and psychometric characteristics of masked, white coat and sustained hypertensives. Three groups of consecutive subjects with masked (n ¼ 100, age 59 ± 11 years), white coat (n ¼ 100, 60 ± 10 years) and sustained hypertension (n ¼ 100, 60 ± 11 years) diagnosed by ambulatory BP monitoring were compared. Masked hypertensives had higher educational level, exercised more frequently, received fewer drugs and sensed more responsibilities at work than at home. Their left ventricular hypertrophy indexes fall inbetween those with white coat and sustained, the latter having the highest values. The estimated total cardiovascular risk was intermediate between white coat and sustained, whereas their cardiovascular morbidity and renal disease was higher than that of white coat and similar to sustained. Psychological profile analysis showed lower score for type-A personality and their mood behaviour in the hypomania-euthymia range compared with white coat and sustained hypertensives. The cardiovascular risk of masked hypertensives is higher than that of white coat and similar to sustained. Masked hypertensives have higher educational level, better physical training and different personality/mood pattern than white coat and sustained.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Masked, white coat and sustained hypertension: comparison of target organ damage and psychometric parameters

Konstantopoulou

Papargyriou

et al. 2009

J Hum Hypertens

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“…Whether young age is a consistent feature of MH is a matter of some disagreement (11,14,24,25), with some reports not finding this association.…”

Section: Who Should Be Tested For Mh?mentioning

confidence: 99%

“…In addition to the factors mentioned by the European Society of Hypertension (23), other characteristics of MH have been identified: obesity (12)(13)(14)(15); impaired baroreflex sensitivity (20); current or past smoking (14,22,25); increased serum creatinine levels (14); increased urinary albumin excretion (16); high heart rate (24); and increased alcohol consumption (22,25). Although the list is becoming quite long, these factors, taken together, can lead one to suspect MH in a higher risk patient who may be expected to have BP readings in the hypertensive range.…”

Section: Who Should Be Tested For Mh?mentioning

confidence: 99%

Masked hypertension: A common but insidious presentation of hypertension

McKay

Myers

Bolli³

et al. 2006

Canadian Journal of Cardiology

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M asked hypertension (MH) is strongly linked to an increased risk of heart disease and stroke (1-4). Mounting evidence suggests that MH must be taken into account in the assessment of blood pressure (BP), but little is known about how masked hypertensive patients are identified or how they should be managed. Despite prevalence estimates of at least 8% to 10% in the general population and a prognosis similar to sustained hypertension, the term, the meaning and the importance of MH are not widely understood. The present article provides some background on MH, describes its clinical importance and discusses some aspects of management in clinical practice. What is MH?MH is present when a normal office BP (OBP) is recorded in a patient with ambulatory BP (ABP) or home BP (HBP) readings in the hypertensive range (5). As the term implies, the hypertension is real but is masked to the physician. Patients with this condition have a normal or, more commonly, high normal OBP of less than 140/90 mmHg. Although ABP and HBP testing is not performed routinely in patients whose BP is less than 140/90 mmHg, various research studies have examined the relationship between normal OBP and ABP or HBP in a variety of populations. Over the past three years, four large, prospective studies (1-4) have reported that patients with MH exhibit a risk profile similar to those who have sustained hypertension.However, many health care professionals are unfamiliar with the concept of MH. This is possibly because of inconsistent nomenclature in the scientific or medical literature. However, the phenomenon of MH is not new. The classic paper on ABP monitoring was written by Perloff et al in 1983 (6), and demonstrated not only the superiority of ABP over OBP in predicting clinical outcomes, but also showed poorer outcomes in patients who had higher ABP values compared with their borderline or mildly hypertensive OBP. Since then, others who have observed this same phenomenon have called it a variety of names, including white coat normotension (7), reverse white coat (8), inverse white coat (9), home or isolated home hypertension (7,10), isolated ambulatory hypertension (11), isolated uncontrolled hypertension at home (12) and occult office hypertension (13). Pickering et al (5) suggested the term 'masked hypertension', and this term appears to have become the standard terminology to describe patients who have a normal OBP but elevated HBP or ABP. A patient has masked hypertension when his office blood pressure is less than 140/90 mmHg but his ambulatory or home blood pressure readings are in the hypertensive range. Several recent studies have demonstrated that cardiovascular risk is similar between those with masked hypertension and those with sustained hypertension. The prevalence of masked hypertension in Canada is not known, but data from other countries suggest rates greater than 8%. Physicians need to use careful clinical judgment to identify and treat subjects with masked hypertension. The present review discusses masked hypertension, its imp...

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“…20 The exact prevalence of MHT was achieved with the introduction of ABPM that showed a diagnostic sensitivity higher than home BP monitoring (HBPM). 21 Indeed analysis from PAMELA reported a prevalence of 9%; 22 other studies reported frequencies ranging from 10.2% 23 to 23%, 24 reaching even 48%. 25 It might be fair to say that since the WCHT is more common in the elderly, consequently MHT should gradually decline with age.…”

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confidence: 95%

White-coat hypertension and masked hypertension: an update

2015

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The precise quantification of blood pressure (BP) is an essential step to reach the largest number of correct diagnosis of arterial hypertension (AH) and consequently to optimize the anti-hypertensive therapy. Since the invention of the first sphygmomanometer in 1896, Riva-Rocci observed the inaccuracy of that method for a correct BP determination: 1 the simple appearance of a doctor was accompanied by an immediate rise in BP in some patients. Years later Pickering called this phenomenon white coat hypertension (WCHT). 2 The introduction of fully-automated BP measurement during the 24 h (ambulatory blood pressure monitoring, ABPM) allowed to observe the entire circadian BP profile, highlighting how BP could be normal in physician office and elevated at home, especially during the nocturnal period. 3 This last observation was named masked hypertension (MHT). 4 WCHT is defined as office BP persistently ≥140 mmHg systolic, ≥90 mmHG diastolic, or both, whereas out-of-office BP is within normal (<130/80 mmHg for 24-h mean BP, or <135/85 mmHG for home BP). 5-7 Medical environment triggers this alarm reaction, 8 through the hyperactivation of sympathetic nervous system. 9 It peaked 2-4 min after the start of the visit and continued throughout the duration of the physician's visit. 10 For this reason, international guidelines recommended to record at least two ABPM to confirm the diagnosis of WCHT and to determine the possible development of sustained hypertension. 11 Further WCHT can be divided into true WCH, when both home BP values and ABPM values are normal, and partial WCHT, when only one of these out-of-office measurements is normal. 5 If WCHT can determinate an overdiagnosis of AH, on the other hand some subjects present normal office BP values in contrast to pathological 24-h BP profile on ABPM or altered home BP. This reverse white-coat effect or MHT 12,13 is related to a worse cardiovascular (CV) prognosis 14 and also to the development of a target organ damage (TOD) comparable to sustained hypertension patients 15 (Table 1). Both WCHT and MHT are examples of how the correct evaluation of BP profile is a difficult challenge and how their better knowledge can lead to a more precise diagnosis and consequently to a proper treatment of AH. EpidemiologyThe prevalence of WCHT and MHT is not completely clear. AS a confounding factor several studies showed different values for normal BP. Regarding White-coat hypertension and masked hypertension: an update ABSTRACTWhite coat hypertension and masked hypertension are two conditions with a controversial role in the beginning and the progression of the cardiovascular disease. We focused our attention on the definition, the epidemiology, the pathophysiology and the clinical consequences of these two conditions, with an attention also on the management. This review was based on the papers found on PubMed and MEDLINE up to August 2015. The search terms used were white coat hypertension, masked hypertension in combination with epidemiology, management and pathophysiology.

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How Often Do Office Blood Pressure Measurements Fail to Identify True Hypertension?: An Exploration of White-Coat Normotension

Cited by 90 publications

References 26 publications

Masked, white coat and sustained hypertension: comparison of target organ damage and psychometric parameters

Masked, white coat and sustained hypertension: comparison of target organ damage and psychometric parameters

Masked hypertension: A common but insidious presentation of hypertension

White-coat hypertension and masked hypertension: an update

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