Prognostic Relevance of Masked Hypertension in Subjects With Prehypertension

Pierdomenico, Sante D.; Pannarale, Giuseppe; Rabbia, Franco; Lapenna, Domenico; Licitra, R.; Zito, M.; Campanella, Mario; Gaudio, Carlo; Veglio, Franco; Cuccurullo, Franco

doi:10.1038/ajh.2008.196

Cited by 43 publications

(31 citation statements)

References 21 publications

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“…21 When this is found, further examinations are mandatory because data are remarkably consistent that in masked hypertension (1) there is a greater prevalence and severity of metabolic risk factors, including overweight, dyslipidemia, impaired glucose tolerance, and diabetes mellitus; (2) subclinical cardiac, vascular, or renal damage is more common; (3) the long-term risk of developing sustained hypertension, diabetes mellitus, or left ventricular hypertrophy is 2 to 3 times greater than that of individuals with normal in-and out-of-office BP; and (4) there is also a greater incidence of cardiovascular morbid and fatal events, with an overall risk that is either intermediate or, in some studies, closer to that of sustained hypertension than to true normotension. [95][96][97][98][99][100][101][102][103][104][105][106][107] This represents a sort of a proof of concept of the prognostic impact of ambulatory, and more in general out-of-office BP values vis-à-vis the traditional BP classification based on office BP measurements only.…”

Section: Masked Hypertensionmentioning

confidence: 96%

Clinical Value of Ambulatory Blood Pressure

Mancia

Verdecchia

2015

Circulation Research

188

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This article reviews the clinical value of ambulatory blood pressure (BP) vis-à-vis the traditional BP measurements taken in the physician's office or in the hospital. Mention is initially made that longitudinal studies conducted in the general population or in hypertensive cohorts have shown that ambulatory BP provides a more accurate prediction of outcome than office BP. Namely, that (1) the risk of cardiovascular events increases in a less steep fashion with office than with 24-hour mean BP, (2) the 24-hour BP-dependent prediction is maintained after adjustment for office BP values, and (3) among individuals with normal office BP, those with increased ambulatory BP (masked hypertension) have an increased prevalence of organ damage, a more frequent unfavorable metabolic profile and a higher risk of new onset sustained hypertension, diabetes mellitus, and cardiovascular events than those with normal ambulatory BP. It is further mentioned, however, that more recently similar observations have been made for individuals with high office but normal ambulatory BP (white coat hypertension) suggesting a complementary role of out-of-office and office BP values in the determination of patients' prognosis. The evidence in favor of an independent prognostic value also of some within 24-hour BP phenomena (night BP reduction or absolute values, short-term BP variations, and morning BP surge) is then critically appraised for its elements of strength and weakness. Finally, whether the clinical advantages of ambulatory BP make this approach necessary for all patients with hypertension is discussed. The conclusion is that this is at present still premature because crucial evidence pro or against routine use of this approach in untreated and treated hypertensives is not yet available. It will be crucial for future studies to determine whether, compared with a treatment guided by office BP, a treatment tailored on ambulatory BP allows to improve prevention or regression of organ damage as well as protection from major cardiovascular complications to a degree that justifies the complexity and cost of the procedure.

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Section: Masked Hypertensionmentioning

confidence: 96%

Clinical Value of Ambulatory Blood Pressure

Mancia

Verdecchia

2015

Circulation Research

188

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“…Presently, scarce data exist from prior studies as to whether MHT adds prognostic information in individuals with PHT. In what to our knowledge is the only published study to examine the predictive value of MHT for CVD events in participants with PHT, Pierdomenico et al 29 found that in participants with PHT, MHT was associated with a significantly higher rate of CVD events, compared to those participants without MHT ("true PHT"). This study was limited by a small number of events (18 events in MHT and PHT vs. 11 events in true PHT) and potentially incomplete examination of confounders such as male gender.…”

Section: Masked Hypertension and Prehypertensionmentioning

confidence: 99%

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

Shimbo

Newman

Schwartz

2012

American Journal of Hypertension

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In 2002, Dr Thomas Pickering and our group introduced the term masked hypertension (MHT) 1 to describe individuals with normal clinic blood pressure (CBP) levels (<140/90 mm Hg) and ambulatory hypertension (awake ≥135/85 mm Hg). MHT is associated with increased left ventricular (LV) mass, 2 a marker of cardiovascular end-organ damage, and an increased risk of cardiovascular disease (CVD) events, that is significantly more than in sustained normotension (clinic and ambulatory normotension). [3][4][5][6][7] The confluence of increased CVD risk, a failure to be diagnosed by the conventional approach of blood pressure measurement in the clinic setting, and relatively high prevalence 8-11 makes MHT a public health concern.Epidemiologic studies have shown that CBP in the prehypertension (PHT) range (i.e., mean systolic blood pressure (SBP) 120-139 mm Hg or mean diastolic blood pressure (DBP) 80-89 mm Hg) confer an increased CVD risk. 12 PHT is associated with higher levels of LV mass 13 and also a higher risk of CVD events, 12 compared to optimal blood pressure levels (<120/80 mm Hg).Recent evidence suggests that CBP levels are significantly higher among individuals with MHT compared to individuals with sustained normotension, 9 despite both groups having CBP levels in the normal range (<140/90 mm Hg). These findings suggest that the prevalence of PHT may be disproportionally higher in MHT than in sustained normotension, or alternatively that the prevalence of MHT may be higher in PHT than in those with optimal CBP. These hypotheses have not been directly examined in previous studies, particularly when out-of-office blood pressure is determined by an ambulatory blood pressure (ABP) monitoring. Furthermore, the relative contributions of MHT and PHT to CVD risk are also unclear. The primary aim of this study was to evaluate the BackgroundMasked hypertension (MHT) and prehypertension (PHT) are both associated with an increase in cardiovascular disease (CVD) risk, relative to sustained normotension. This study examined the diagnostic overlap between MHT and PHT, and their interrelationships with left ventricular (LV) mass index (LVMI), a marker of cardiovascular end-organ damage.

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“…4,[21][22][23][24][25] Both conditions are commonly observed in the same individual and are associated with additive effects in the occurrence of cardiovascular events. 26 However, the risk factors and mechanisms leading to these conditions are not completely understood. 27 OSA may be associated with prehypertension and masked hypertension for at least 3 reasons.…”

Section: Drager Et Al Osa Prehypertension and Masked Hypertensionmentioning

confidence: 99%

The Effects of Continuous Positive Airway Pressure on Prehypertension and Masked Hypertension in Men With Severe Obstructive Sleep Apnea

et al. 2011

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Abstract-Obstructive sleep apnea and hypertension are common conditions that frequently coexist. Continuous positive airway pressure (CPAP) reduces blood pressure in patients with obstructive sleep apnea and sustained hypertension. However, the impact of CPAP on patients with obstructive sleep apnea and prehypertension and masked hypertension, conditions associated with increased cardiovascular risk, is unknown. Thirty-six male patients (age, 43Ϯ7 years; body mass index, 28.8Ϯ3.0 kg/m 2 ) with untreated severe obstructive sleep apnea (apnea-hypopnea index, 56Ϯ22 events/hr on polysomnography) with diagnostic criteria for prehypertension and/or masked hypertension, based on office and 24-hour ambulatory blood pressure monitoring, respectively, were studied. The patients randomized to no treatment (control; nϭ18) or CPAP (nϭ18) for 3 months had similar frequency of prehypertension and masked hypertension at study entry. There were no significant changes in blood pressure in patients randomized to the control group. In contrast, patients randomized to CPAP presented significant reduction in office systolic (from 126Ϯ5 to 121Ϯ7 mm Hg; Pϭ0.001) and a trend for diastolic blood pressure (from 75Ϯ7 to 73Ϯ8 mm Hg; Pϭ0.08) as well as a significant decrease in daytime and nighttime systolic and diastolic blood pressure (PϽ0.05 for each comparison). There was a significant reduction in the frequency of prehypertension (from 94% to 55%; Pϭ0.02) and masked hypertension (from 39% to 5%; Pϭ0.04) only in the CPAP group. In conclusion, effective CPAP therapy promotes significant reduction in the frequency of prehypertension and masked hypertension by promoting significant blood pressure reductions in patients with severe obstructive sleep apnea.

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Prognostic Relevance of Masked Hypertension in Subjects With Prehypertension

Cited by 43 publications

References 21 publications

Clinical Value of Ambulatory Blood Pressure

Clinical Value of Ambulatory Blood Pressure

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

The Effects of Continuous Positive Airway Pressure on Prehypertension and Masked Hypertension in Men With Severe Obstructive Sleep Apnea

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