Masked hypertension and prehypertension: diagnostic overlap and interrelationships with left ventricular mass: the masked hypertension study

Shimbo, Daichi; Newman, Jonathan; Schwartz, Joseph E.

doi:10.1038/ajh.2012.15

Cited by 97 publications

(110 citation statements)

References 34 publications

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“…Echocardiographic left ventricular mass index was higher in persons with masked hypertension and in persons with prehypertension (19). In 652 Swiss persons, mean age 48 years, masked hypertension was present in 15.8% of persons (20).…”

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confidence: 89%

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Masked hypertension

Aronow¹

2017

Ann. Transl. Med.

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confidence: 89%

“…In 813 participants, mean age 45 years, without treated hypertension in the Masked Hypertension Study, 15.2% had masked hypertension (19). Echocardiographic left ventricular mass index was higher in persons with masked hypertension and in persons with prehypertension (19).…”

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confidence: 97%

Masked hypertension

Aronow¹

2017

Ann. Transl. Med.

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“…74 Although clinic BP is in the normal range in subjects with MHT, optimal values (<120/80 mmHg) are related to a lower prevalence of this alteration with a lower presence of TOD 75 and also with a lower incidence of MHT during a long follow-up period. 76 However, this cut-off value lead to an high false-positive rate. 77 Home BP measurement could be useful in the diagnosis and in the prognostic stratification, also for the nocturnal period, 78 but ABPM seems to be the best method to make an accurate diagnosis.…”

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confidence: 99%

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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“…Patients with pre-HTN according to office BP, at high risk (diabetes, obstructive sleep apnea, and smoking), or evidence of target organ damage (chronic kidney disease and left ventricular hypertrophy) and normal office BP should be screened with HBPM. [33][34][35] Nighttime and daytime BP recordings with ABPM may better define cardiovascular risk and guide treatment, as it prevents incomplete treatment of uncontrolled masked HTN.…”

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confidence: 99%