Reproducibility of blood pressure variability, white‐coat effect and dipping pattern in untreated, uncomplicated and newly diagnosed essential hypertension

Stenehjem, Aud; Os, Ingrid

doi:10.1080/08037050410021432

Cited by 51 publications

(45 citation statements)

References 35 publications

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“…These parameters contribute to the diagnosis and treatment of hypertension. [4][5][6] The measurement of ABP has enabled us to identify a subgroup of individuals with white-coat hypertension (WCHT), showing persistent hypertensive casual BP (CBP) but normal ABP, and a subgroup of individuals with masked hypertension (MHT), showing normal CBP but hypertensive ABP. MHT is reported to be associated strongly with high risk of morbidity and mortality from cardiovascular disease (CVD).…”

Section: Introductionmentioning

confidence: 99%

Usefulness of assessing masked and white-coat hypertension by ambulatory blood pressure monitoring for determining prevalent risk of chronic kidney disease: the Ohasama study

et al. 2010

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Masked hypertension (MHT) is considered to be associated with organ damage, whereas the association of white-coat hypertension (WCHT) with organ damage remains controversial. Using home blood pressure measurements, we have previously reported that MHT is associated with a risk of chronic kidney disease (CKD) compared with sustained normal blood pressure (SNBP), although WCHT was not significantly related to CKD in a general Japanese population. The objective of this study was to examine CKD risk associated with WCHT and MHT as determined by ambulatory blood pressure (ABP) monitoring. Among 1023 residents in the general Japanese population of Ohasama, ABP and casual blood pressure (CBP) levels were recorded and blood and urine samples were collected. CKD was defined as a positive proteinuria and/or estimated glomerular filtration rate o60 ml min À1 per 1.73 m 2 . Participants were categorized into four groups using daytime ABP of 140/85 mm Hg and CBP of 140/90 mm Hg as cutoff points: SNBP, 60.0%; WCHT, 15.4%; MHT, 15.0%; and sustained hypertension (SHT), 9.6%. Odds ratios (ORs) for prevalence of CKD were calculated using a multiple logistic regression model. Compared with SNBP, risk of CKD was significantly higher in SHT (OR, 2.81; 95% confidence interval (CI), 1.66-4.75; P¼0.0001), MHT (OR, 2.29; 95% CI, 1.45-3.63; P¼0.0004) and WCHT (OR, 1.67; 95% CI, 1.03-2.71; P¼0.0368). CKD was significantly associated with MHT and WCHT on the basis of ABP monitoring compared with SNBP in the general Japanese population. Keywords: ambulatory blood pressure; chronic kidney disease; masked hypertension; white-coat hypertension INTRODUCTION Ambulatory blood pressure (ABP) has recently been the focus of large amounts of research, and the utility and usefulness of this technique have been recognized and established in the diagnosis and management of hypertension. 1-3 ABP is also considered as a useful tool for detecting overall blood pressure (BP) load, nighttime BP level and circadian and short-term variations in BP. These parameters contribute to the diagnosis and treatment of hypertension. [4][5][6] The measurement of ABP has enabled us to identify a subgroup of individuals with white-coat hypertension (WCHT), showing persistent hypertensive casual BP (CBP) but normal ABP, and a subgroup of individuals with masked hypertension (MHT), showing normal CBP but hypertensive ABP. MHT is reported to be associated strongly with high risk of

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Section: Introductionmentioning

confidence: 99%

Usefulness of assessing masked and white-coat hypertension by ambulatory blood pressure monitoring for determining prevalent risk of chronic kidney disease: the Ohasama study

et al. 2010

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“…In other study [18], when the fi rst 24-h assessment of the dipping pattern was compared to the estimation on the basis of 48-h recording, 11% hypertensive subjects switched patterns, similarly for SBP and DBP and with no difference between treated and untreated patients. In untreated patients with newly diagnosed hypertension, the nocturnal dipping pattern has been repeatable in 82% of them when re-assessed after 4 weeks [19]. Signifi cant intra-subject variations in the diurnal fl uctuations in BP have been found by Manning et al [20] over a 12-month observation.…”

Section: Reproducibility Of Dipping Pattern Assessmentmentioning

confidence: 75%

Blood pressure variability: Epidemiological and clinical issues

Krzych¹,

Bochenek²

2013

Cardiol J.

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“…The questionable reproducibility of the clinic-aABP difference is another potential source of inaccuracy. 27,28 It seems possible that in the case of clinic nonresponders with high systolic BP variability, computation of the clinic-aABP difference based on repeated ABPM would give inconsistent values, providing an explanation for unsatisfactory reproducibility. The referred population of patients, some being treated (with variable ABP control), some untreated, is another limitation, although subgroup analysis by hypertension treatment did not change the results.…”

Section: Discussionmentioning

confidence: 99%

The role of blood pressure variability in misdiagnosed clinic hypertension

et al. 2010

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Blood pressure (BP) assessment may be vulnerable to bias by increased BP variability. Uncertainty in determining BP control is inherent to the clinic setting. We analyzed a registry of 3949 patients referred for ambulatory BP monitoring. The difference between clinic and ambulatory readings was plotted against ambulatory BP variability, assessed by standard deviation. In addition, BP variability of patients with clinic and awake ambulatory hypertension was compared with that of patients with controlled BP and sustained hypertension, respectively. The average clinic-ambulatory systolic BP difference was 5 ± 17/3 ± 9 mm Hg. Patients with 410-mm Hg systolic difference had higher systolic ambulatory BP standard deviation (14.9 ± 4.2 mm Hg) compared to patients with a difference of 0 to 10-mm Hg (standard deviation 12.5 ± 3.7 mm Hg). Patients with masking (negative clinic-ambulatory BP difference) also had comparatively higher standard deviation (14.4±4.9 mm Hg Po0.0001). Greater ambulatory BP variability carried increased risk for both false diagnosis of hypertension (odds ratio (OR): 2.09, 95% confidence interval (CI): 1.58-2.76), and missed clinic diagnosis of hypertension (OR: 1.86, 95% confidence interval: 1.48-2.33). The former was more striking in women, in whom high variability carried greater odds for false diagnosis of hypertension (OR: 2.76, 95% confidence interval: 1.96-3.89). Thus, clinic misjudgment of BP control may stem in part from high BP variability. Women with high BP variability are more susceptible to hypertension misdiagnosis. It is possible that high BP variability contributes to the increased cardiovascular risk related to both masked hypertension and white coat hypertension.

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Reproducibility of blood pressure variability, white‐coat effect and dipping pattern in untreated, uncomplicated and newly diagnosed essential hypertension

Cited by 51 publications

References 35 publications

Usefulness of assessing masked and white-coat hypertension by ambulatory blood pressure monitoring for determining prevalent risk of chronic kidney disease: the Ohasama study

Usefulness of assessing masked and white-coat hypertension by ambulatory blood pressure monitoring for determining prevalent risk of chronic kidney disease: the Ohasama study

Blood pressure variability: Epidemiological and clinical issues

The role of blood pressure variability in misdiagnosed clinic hypertension

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