Target Organ Complications and Cardiovascular Events Associated With Masked Hypertension and White-Coat Hypertension

Tientcheu, Danielle D.; Ayers, Colby; Das, Sandeep R; McGuire, Darren K.; Lemos, James A. de; Khera, Amit; Kaplan, Norman M.; Victor, Ronald G.; Vongpatanasin, Wanpen

doi:10.1016/j.jacc.2015.09.007

Cited by 174 publications

(102 citation statements)

References 29 publications

(28 reference statements)

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“…Our study findings are relevant for clinical practice because they reinforce the importance of ABPM, or potentially other methods such as home BP measurement 31 as an alternative, for better defining BP status and classification of white-coat and masked hypertension phenomena in routine clinical practice.…”

Section: Discussionsupporting

confidence: 66%

Clinic Versus Daytime Ambulatory Blood Pressure Difference in Hypertensive Patients

et al. 2017

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C onventional blood pressure (BP) determined in the clinic has been the standard of defining BP status for many decades.1 However, out-of-clinic BP (eg, ambulatory BP monitoring [ABPM]) can provide a more accurate estimate of the true BP and better predict clinical outcomes than conventional BP.1-3 The Framingham Heart Study showed that clinic systolic BP (SBP) rises from adolescence through most of adulthood. 4 In contrast, diastolic BP (DBP) initially increases in young adulthood, levels off at age 50 to 55 years, and then usually decreases after age 60 to 65. BP trajectories obtained using ABPM also increase with age, but the age gradients are less steep than those from conventional BP. 5 It has long been reported that seated clinic BP is usually higher than daytime ambulatory or home-measured BP, mostly in hypertensive patients. [5][6][7][8][9][10][11] The difference in clinic-ambulatory BP values has been used to quantify the so-called whitecoat effect (WCE), which has been related, at least in part, to the alert reaction and transient increase in BP that often occurs during the clinic visit.12,13 Some studies have reported that the clinic-daytime BP differences increase progressively both Abstract-Clinic blood pressure (BP) is usually higher than daytime ambulatory BP in hypertensive patients, but some recent studies have challenged this view, suggesting that this relationship is strongly influenced by age. We used the Spanish ambulatory BP monitoring cohort to examine differences between clinic and daytime BP by age among 104 639 adult hypertensive patients (office systolic/diastolic BP ≥140/90 mm Hg or treated) in usual primary-care practice, across the wide age spectrum. To assess the impact of age, cardiovascular variables, and clinic BP on the clinic-daytime BP differences, we built multivariable regression models of the average BP differences, white-coat hypertension (high clinic BP and normal daytime BP), and masked hypertension (normal clinic BP and high daytime BP). In most patients, mean clinic BP values were higher than daytime BP at all ages. Some 36.7% of patients had white-coat hypertension (amounting to 50% at clinic systolic BP of 140-159 mm Hg) and 3.9% had masked hypertension (amounting to 18% at clinic systolic BP of 130-139 mm Hg). Age explained 0.1% to 1.7% of the variance of quantitative or categorical BP differences (P<0.001). Cardiovascular variables explained an additional 1.6% to 3.4% of the variance (P<0.001). Finally, clinic BP generally explained ≥20% more of the variance (P<0.01). In this large study in usual clinical practice, clinic BP misclassified hypertension status in >40% of patients. This misclassification was not importantly influenced by age but was more evident in patients with borderline/grade 1 hypertension. These findings reinforce the importance of ambulatory BP monitoring for defining BP status in routine clinical practice. (Hypertension. 2017;69:211-219.

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Section: Discussionsupporting

confidence: 66%

Clinic Versus Daytime Ambulatory Blood Pressure Difference in Hypertensive Patients

et al. 2017

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“…Furthermore, a recent study from the DHS used the same home BP definition to describe the associations of white coat and masked hypertension with target organ complications and cardiovascular events. 46 Fifth, we did not adjust for multiple testing, although findings remained consistent after multivariable adjustment; validation of our findings in other epidemiological cohorts is warranted. Lastly, our findings may not be generalizable to individuals older than 65 years or other racial/ethnic groups not included in the DHS (e.g., Asians).…”

Section: Discussionmentioning

confidence: 80%

Regional Fat Distribution and Blood Pressure Level and Variability

et al. 2016

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Our aim was to investigate the associations of regional fat distribution with home and office blood pressure (BP) levels and variability. Participants in the Dallas Heart Study, a multiethnic cohort, underwent five BP measurements on three occasions over 5 months (two in-home and one in-office) and quantification of visceral (VAT), abdominal subcutaneous adipose tissue (SAT), and liver fat by MRI, and lower body subcutaneous fat by dual x-ray absorptiometry. The relation of regional adiposity with short-term (within-visit) and long-term (over all visits) mean BP and average real variability (ARV) was assessed with multivariable linear regression. 2,595 participants mean age 44 years; 54% women, 48% black; and mean BMI 29 kg/m2 were included. Mean SBP/DBP was 127/79mmHg and ARVSBP was 9.8mmHg over 3 visits. In multivariable-adjusted models, higher amount of VAT was associated with higher short-term (both home and office) and long-term mean SBP (β[SE]: 1.9[0.5], 2.7[0.5], and 2.1[0.5], respectively, all P<0.001), and with lower long-term ARVSBP (β[SE]: -0.5[0.2], P<0.05). In contrast, lower body fat was associated with lower short-term home and long-term mean BP (β[SE]: -0.30[0.13] and -0.24[0.1], respectively, both P<0.05). Neither SAT or liver fat were associated with BP levels or variability. In conclusion, excess visceral fat was associated with persistently higher short- and long-term mean BP level and with lower long-term BP variability whereas lower body fat was associated with lower short- and long-term mean BP. Persistently elevated BP, coupled with lower variability, may partially explain increased risk for cardiac hypertrophy and failure related to visceral adiposity.

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“…Prior studies have found masked hypertension to be associated with renal dysfunction (reduced estimated glomerular filtration ratio: eGFR, proteinuria) and vascular dysfunction (increased pulse wave velocity). (43–45) Masked hypertension has also been associated with increased left ventricular mass index. In a recent meta-analysis by Cuspidi et al, as compared to individuals with sustained normotension, individuals with masked hypertension had an increased left ventricular mass index (79.2 ± 0.35 g/m 2 versus 91.6 ± 4.0 g/m 2 , respectively) and an increased prevalence of left ventricular hypertrophy (3.7% versus 14.1%, respectively).…”

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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Target Organ Complications and Cardiovascular Events Associated With Masked Hypertension and White-Coat Hypertension

Cited by 174 publications

References 29 publications

Clinic Versus Daytime Ambulatory Blood Pressure Difference in Hypertensive Patients

Clinic Versus Daytime Ambulatory Blood Pressure Difference in Hypertensive Patients

Regional Fat Distribution and Blood Pressure Level and Variability

An Update on Masked Hypertension

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