Long-Term Stroke Risk Due to Partial White-Coat or Masked Hypertension Based on Home and Ambulatory Blood Pressure Measurements

Satoh, Michihiro; Asayama, Kei; Kikuya, Masahiro; Inoue, Ryusuke; Metoki, Hirohito; Miki, Hirokazu; Tsubota‐Utsugi, Megumi; Obara, Taku; Ishiguro, Aya; Murakami, Keiko; Matsuda, Ayako; Yasui, Daisaku; Murakami, Takahisa; Mano, Nariyasu; Imai, Yutaka; Ohkubo, Takayoshi

doi:10.1161/hypertensionaha.115.06461

Cited by 82 publications

(64 citation statements)

References 41 publications

(43 reference statements)

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“…Studying Japanese adults in the Ohasama cohort, Satoh et al looked at the association of stroke with masked hypertension diagnosed on ABPM only (using daytime, 24-hour, and/or nighttime periods), HBPM only, or on both out-of-clinic BP measurement modalities. (49) They found that masked hypertension detected on both ABPM and HBPM was associated with an increased risk of stroke (HR 2.05, 95% CI 1.23 – 3.41) compared to sustained normotension defined as having non-elevated clinic BP, non-elevated BP on ABPM, and non-elevated BP on HBPM. Further, this risk was also elevated among individuals with masked hypertension diagnosed only on ABPM but not on HBPM (HR 1.93, 95% CI 1.15 – 3.24); and when diagnosed on HBPM but not ABPM (HR 2.26, 95% CI 1.32 – 3.89).…”

Section: Adverse Outcomesmentioning

confidence: 99%

An Update on Masked Hypertension

et al. 2017

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Masked hypertension refers to the phenomenon of having a non-elevated clinic blood pressure (BP) despite having an elevated out-of-clinic BP. Masked hypertension is a common phenotype with a cardiovascular risk profile similar to that of sustained hypertension, defined as elevated clinic and out-of-clinic BP. Current guidelines offer little guidance on the best practices for detecting and treating masked hypertension. This is in part due to insufficient evidence upon which to base recommendations as many questions remain regarding the optimal clinical management of masked hypertension. In this review, we will discuss the recent literature on masked hypertension related to disease prevalence, diagnosis, screening strategies, adverse outcomes, and treatment, and will highlight critical areas for future research.

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Section: Adverse Outcomesmentioning

confidence: 99%

An Update on Masked Hypertension

et al. 2017

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“…Ambulatory BP level had already many years ago been shown to be better predictor for cardiovascular complications as compared to clinic BP readings [24,25]. This was confirmed by prospective studies dealt with estimation of outcomes in patients with different BP phenotypesrisk of myocardial infarction, stroke, lethal outcomes and other cardiovascular complications was significantly higher in masked uncontrolled hypertension as compared to normotension and well controlled hypertension and was similar to cardiovascular risk in sustained hypertension [7,[26][27][28][29]. For instance, in accordance to Satoh M. et al data [29] (with mean follow-up of 17.1 years) the risk of stroke in masked un-АГТ -38,8% зимой и 27,8% летом.…”

Section: Discussionmentioning

confidence: 92%

“…Уже мно-го лет назад был доказан факт, что амбулаторное АД -луч-ший предиктор сердечно-сосудистых осложнений по сравнению с показателями клинических измерений [24,25]. Это подтверждают и проспективные исследования, по-священные оценке исходов при разных фенотипах АД, -риск инфаркта миокарда, мозгового инсульта, летальных исходов и других сердечно-сосудистых осложнений при скрытой АГ значимо выше, чем при нормотонии и эф-фективной АГТ, а также сопоставим с риском при устойчивой АГ [7,[26][27][28][29]. Например, в исследовании Satoh M. и соавт.…”

Section: Discussionunclassified

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Blood Pressure Phenotypes in Treated Hypertensive Patients in Summer and Winter: Focus on Masked Uncontrolled Hypertension. Part 1: Blood Pressure Phenotypes Prevalence

Смирнова

Горбунов

Boytsov

et al. 2017

Racionalʹnaâ farmakoterapiâ v kardiologii

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Background. The seasonal variability of blood pressure (BP) and cardiovascular morbidity and mortality motivates researchers to search for the new approaches of the antihypertensive treatment (AHT) efficacy assessment, including the analysis of interrelation between clinic and ambulatory BP, i.e. BP phenotypes. Aim. To evaluate the prevalence of BP phenotypes in treated hypertensive outpatients both in winter and summer. Material and methods. Hypertensive patients under regular AHT with available data of clinic BP and 24-hour BP monitoring both in winter and summer seasons (n=477) were selected from a outpatient database with clinic BP <160/100 mm Hg (n=1762). The BP threshold values from current guidelines were used for the BP phenotypes definition. The "controlled hypertension" phenotype was detected when clinic and ambulatory BP levels were less than threshold values, the "uncontrolled hypertension" -when both levels exceeded the thresholds, the "white coat hypertension (WCH) in treated patients" -when clinic BP was only increased, the "masked uncontrolled hypertension" phenotype was ascertained if ambulatory BP was only elevated. Results. The study included 232 patients examined in Ivanovo (a relatively cold region; mean age 53.5±9.3 years; 28% men; clinic BP 121.7±7.9 mm Hg; mean duration of hypertension 4.6±6.3 years) and 245 patients from Saratov (a relatively hot region; mean age 58.3±10.6 years; 56.3% men; clinic BP 127.5±14.9 mmHg; mean duration of hypertension 9.2±9.2 years; р<0.0001). In the Ivanovo cohort, ratio of BP phenotypes in summer and winter did not differ; the "masked uncontrolled hypertension" phenotype prevailed (62.1% and 63.8% in winter and summer, respectively); AHT was effective in 27.6% and 29.7% of the patients in winter and summer, respectively. The prevalence of other phenotypes was low: uncontrolled hypertension -9.5% in winter and 6.0% in summer; WCH in treated patients -less than 1% in both seasons. The prevalence of BP phenotypes in the patients examined in Saratov differed in winter and summer (χ 2 =18.127, р<0.0001); the "masked uncontrolled hypertension" phenotype rate was higher in summer than in winter (50.2% and 32.2%, respectively); the rates of other phenotypes were higher in winter: uncontrolled hypertension -38.8% and 27.8%, controlled hypertension -25.3% and 20.8%, WCH -3.7% and 1.2% in winter and summer, respectively. Conclusion. We have found no seasonal changes in BP phenotypes prevalence in relatively younger hypertensive patients in a relatively cold region. The "masked uncontrolled hypertension" phenotype was predominant (>60%) in this region. In contrast, the cohort of relatively older patients with longer hypertension history examined in a relatively warmer region revealed significantly higher rate of masked uncontrolled hypertension in summer (50.2%) while prevalence of all other phenotypes -in winter.

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“…9 According to the above, hypertensive patients in whom normal out-of-office BP required by both techniques, ABPM and HBPM, have an incidence of CV events similar to that of normotensive patients, while those with one of the two measures high and the other normal have an intermediate CV risk among normotensive and sustained hypertensive patients. 10,11 When these out-of-office measurements apply to the monitoring of treated hypertensive patients, it seems that both are useful and reliable. 12,13 When a patient has outof-office BP controlled according to any one of the measures, ABPM or HBPM, CV risk is independent of BP measurement in the office.…”

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confidence: 99%

Is Persistent Office Hypertension in Treated Hypertensive Patients a Benign Condition?

Coll‐de‐Tuero

Vargas-Vila

Torguet

2016

J of Clinical Hypertension

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Arterial stiffness is a powerful and independent risk factor for cardiovascular (CV) disease.1,2 Its prognostic value is added to others including hypertension. 3 The estimation of both stiffness and blood pressure (BP) can provide advantages in individual CV risk determination. 4 "Out-of-office" BP has a better CV prognostic value than office BP in hypertensive patients. This is a common knowledge; however, it is unclear how clinicians use this information in their decision-making.In untreated hypertensive patients at baseline, some authors 5,6 have shown that those with white-coat hypertension (WCH) according to ambulatory BP monitoring (ABPM) have similar CV risk to normotensive patients. However, other cohort studies with longer follow-up periods have shown that the CV risk of patients with WCH according to ABPM or home BP monitoring (HBPM) is intermediate between normotension and sustained hypertension 7 or even higher. 8 There are some factors to consider when discussing these discordant results. First is the rate of detection of subclinical vascular disease in patients diagnosed with WCH. When a patient has subclinical vascular disease, the diagnosis of WCH is not possible. For this reason, it is important to perform the appropriate search of subclinical vascular disease. If not, CV morbidity and mortality can be influenced. Second, patients identified as having WCH have a different profile according to out-of-office BP measurements (ABPM or HBPM). Patients with normal BP by both measurements have a lower basal CV risk than those who have normal values according to only one measurement.9 According to the above, hypertensive patients in whom normal out-of-office BP required by both techniques, ABPM and HBPM, have an incidence of CV events similar to that of normotensive patients, while those with one of the two measures high and the other normal have an intermediate CV risk among normotensive and sustained hypertensive patients. 10,11When these out-of-office measurements apply to the monitoring of treated hypertensive patients, it seems that both are useful and reliable.12,13 When a patient has outof-office BP controlled according to any one of the measures, ABPM or HBPM, CV risk is independent of BP measurement in the office. The work by Barochiner and colleagues 14 published in this issue of the Journal shows that hypertensive patients with persistent office hypertension (high BP in the office and normal HBPM) have greater arterial stiffness, measured by pulse wave velocity, than those with sustained normotension. Previously, Cuspidi and colleagues 15 showed similar findings with both ABPM and HBPM in treated hypertensive patients in relation to left ventricular hypertrophy. The conclusion is that this condition (persistent office hypertension) is perhaps not so benign, as is the case of WCH in untreated hypertensive patients.The study discussed has limitations that require caution in interpreting its results, particularly referring to the BP measurement types: office BP was obtained with only one determ...

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Long-Term Stroke Risk Due to Partial White-Coat or Masked Hypertension Based on Home and Ambulatory Blood Pressure Measurements

Cited by 82 publications

References 41 publications

An Update on Masked Hypertension

An Update on Masked Hypertension

Blood Pressure Phenotypes in Treated Hypertensive Patients in Summer and Winter: Focus on Masked Uncontrolled Hypertension. Part 1: Blood Pressure Phenotypes Prevalence

Is Persistent Office Hypertension in Treated Hypertensive Patients a Benign Condition?

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