P1556Cardiovascular risk in white-coat hypertension individuals stratified by their nocturnal blood pressure dipping status

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Liakos ◽  
E Karpanou ◽  
C Grassos ◽  
M Markou ◽  
G Vyssoulis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Smoking Status ◽  
White Coat ◽  
White Coat Hypertension ◽  
Risk Of Death ◽  
Nocturnal Blood Pressure ◽  
Cholesterol Levels ◽  
Lowering Drug ◽  
Nocturnal Blood Pressure Dipping

Abstract Background/Introduction Nocturnal blood pressure (BP) dipping status, defined by the night-to-day BP ratio, has been correlated with the cardiovascular (CV) risk in patients with arterial hypertension. The risk is higher in those with less than normal or no drop in nocturnal BP while data in extreme dippers are inconsistent. On the other hand, white-coat hypertension (WCHT), defined as an elevated office BP despite a normal out-of-office BP, is characterized by a lower CV risk than that of sustained hypertension and rather comparable with that of true normotension. Purpose The present study assessed the possible relation between the nocturnal BP dipping status and the underlying CV risk in WCHT individuals. Methods Among all individuals examined in our outpatient anti-hypertensive units over the past 15 years, 2310 (42% men, 52.2±13.1 years of age) were diagnosed with WCHT (increased office BP: 156.4±10.0/99.6±6.2 mmHg and normal 24-hour ambulatory BP: 122.4±6.3/75.3±5.4 mmHg) and were enrolled in the study. A night-to-day BP ratio (from the 24-hour ambulatory BP monitoring) 0.8–0.9 defined Normal nocturnal BP Dipping, <0.8 Extreme Dipping, 0.9–1 Mild Dipping and >1 Absence of Dipping. The underlying 10-year CV risk of death in the studied population was calculated with the Hellenic version of the HeartScore (Hellenic Score), as proposed by the current 2018 European Society of Hypertension guidelines, based on age, gender, smoking status, systolic BP and total cholesterol levels. Results From 2310 individuals studied, 1208 (52.3%) were found with Normal Dipping, 386 (16.7%) with Extreme Dipping, 622 (26.9%) with Mild Dipping and 94 (4.1%) with Absence of Dipping. Hellenic Score was 3.21±4.67% in subjects with Normal Dipping, 3.49±4.97% in those with Extreme Dipping, 3.66±5.04% in those with Mild Dipping, 6.21±7.29%, in those with Absence of Dipping (p for trend<0.05) and 3.50±4.99% in the whole cohort of the studied population. Conclusions Nocturnal BP dipping status is closely associated with the underlying CV risk of WCHT individuals. Extreme Dipping, Mild Dipping and especially Absence of Dipping increase CV risk thus necessitating closer follow-up of these individuals and possibly faster initiation of BP-lowering drug treatment.

P803Automatic measurement of blood pressure for one hour in the clinic predicts results of 24-hour ABPM in elderly hypertensive patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B S Stender ◽  
J Stender
Keyword(s):  
Blood Pressure ◽  
White Coat ◽  
White Coat Hypertension ◽  
Waiting Room ◽  
General Applicability ◽  
Non Invasive ◽  
White Coat Effect ◽  
Disturbed Sleep ◽  
Elderly Hypertensive

Abstract Introduction The gold standard in non-invasive assessment of blood pressure (BP) is 24-hour ambulatory BP measurement (24h-ABPM) due to frequent “office-” or “white coat hypertension” effects by measurement in the clinic. But 24h-ABPM is demanding, patients may report discomfort and stress from disturbed sleep. We compared BP measured automatically during one hour (1h-BP) in the waiting room of our clinic with that of 24h-ABPM among elderly hypertensives. Our aim was to investigate whether this less stressful procedure may replace 24h-ABPM in the outpatient follow-up of hypertensives. Hypotheses I) Mean diastolic and systolic BP values measured during one hour in a clinic equal those obtained by 24h-ABPM. II) The minimal BP during 1h-BP measurement equals mean 24h-BP during sleep. Material and methods The population comprised patients referred with known or suspected hypertension. Office BP was measured with Omron M7 Intelli IT. An ABPM apparatus reprogrammed to every 5 min. for one hour was mounted, and 1h-BP was obtained with the patient seated in the waiting room. 24h-ABPM was then performed at home. 110 patients were considered, 11 were excluded due to reported pain, stress or changes of medication, leaving 99 (m/f 32/66, age (SD) 70 (11)) for analysis. Sample size was set in a pilot study by a=0.05, b=0.05, effect size of BP differences systolic 5 (SD 13) and diastolic 3 (SD 8) mmHg. Results were analyzed with Student's paired t-test. Results We found a significant BP drop from office- to 1h- and 24h- BP measurements, i.e. a “white coat” effect. However, mean systolic 1h-BP and mean systolic 24h-BP did not differ, neither did minimal systolic 1h-BP and mean systolic 24h-BP during sleep. Mean diastolic 1h-BP was 4 mm Hg higher than that of 24h-ABPM, and minimal diastolic 1h-BP was 4 mmHg higher than mean diastolic 24h-BP during sleep. mmHg avg (SD) Office-BP 1h-BP mean 24h-BP mean 1h-BP minimum 24h-BPs mean during sleep Systolic 155 (18) 136 (13)* 135 (11)* 127 (12) 127 (13) Diastolic 90 (11) 80 (9)* 76 (8)* 74 (9) 70 (7) *“White-coat effect” significant in comparison with office-BP. No difference between mean systolic 1h-BP and mean systolic 24h-BP, p=0.67. No difference between mean diastolic 1h-BP minus 4 and mean diastolic 24h-BP, p=0.92. No difference between systolic 1h-BP minimum and mean systolic 24h-BP during sleep, p=0.65. Conclusion BP measurement for one hour in the waiting room by an ABPM apparatus may provide sufficient elimination of “office-” or “white coat effects” to replace 24h-ABPM in selected instances. The finding should be challenged in different clinical subpopulations to ensure general applicability.

Nocturnal blood pressure fall and metabolic syndrome score in patients with white coat hypertension

2008 ◽  
Vol 13 (5) ◽  
pp. 251-256 ◽  
Author(s):  
Gregory Vyssoulis ◽  
Eva Karpanou ◽  
Dionysios Adamopoulos ◽  
Stella-Maria Kyvelou ◽  
Elpida Gymnopoulou ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Metabolic Syndrome ◽  
White Coat ◽  
White Coat Hypertension ◽  
Nocturnal Blood Pressure ◽  
Blood Pressure Fall ◽  
Metabolic Syndrome Score ◽  
Pressure Fall

Abstract 5: White Coat Hypertension Stability In Children And Adolescents: Pediatric Nephrology Research Consortium Study

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Yosuke Miyashita ◽  
Coral HANEVOLD ◽  
Anna Faino ◽  
Julia Scher ◽  
Marc B Lande ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Family History ◽  
Children And Adolescents ◽  
White Coat ◽  
White Coat Hypertension ◽  
Mixed Effect ◽  
Interval Time ◽  
Obstructive Sleep ◽  
History Of

There is no pediatric data on whether white coat hypertension (WCH) is a precursor of sustained HTN. The objective of this study was to determine diagnosis changes on follow-up ambulatory blood pressure monitoring (ABPM) in children and adolescents diagnosed with WCH on their initial ABPM and to assess for predictive factors of progression to HTN. Retrospective review was conducted at 11 centers to identify patients with WCH diagnosed by ABPM and had repeat ABPM at least 6 months after the first study. Subjects with secondary HTN, on antihypertensive medication, and diabetes mellitus were excluded. Patients with ADHD were included in the study if medications were stable. Chart review included associated risk factors such as BMI, obstructive sleep apnea, and family history of HTN. ABPM phenotype was determined using the 2014 AHA guidelines. The association between abnormal ABPM diagnosis on follow-up and ABPM index and blood pressure load variables was assessed using univariable generalized linear mixed effect models. Significant ABPM index and load variables (based on p < 0.15) were subsequently added to a multivariable model with the following pre-specified covariates: gender, family history of HTN, age, BMI z-score, ADHD, and interval time between ABPMs. One hundred and one patients met criteria for inclusion with a median age of 14 years (80% males) and median interval time of 14 months (range: 6 – 55 months). On follow-up ABPM, 18% and 32% of patients demonstrated HTN and prehypertension respectively (18 and 32 of 101, respectively). In univariable modeling, awake and nocturnal systolic BP index ≥ 0.9 on the first ABPM were found to be significantly associated with progression to abnormal ABPM [unadjusted OR (95% CI) awake: 4.3 (1.2 – 14.6); nocturnal: 3.2 (1.0 – 10.1)]; however, these associations were not significant after adjusting for pre-specified covariates [adjusted OR (95% CI) awake: 2.7 (0.7-10.4); nocturnal: 2.6 (0.7 – 9.2)]. Approximately half of children and adolescents first diagnosed with WCH progressed to an abnormal ABPM phenotype on follow-up, suggesting that longitudinal follow-up with ABPM is indicated in pediatric WCH patients. We were unable to identify ABPM findings that might predict a higher risk for progression.

scholarly journals White Coat Hypertension in Aircrew: Diagnosis and Clinical Implications

2021 ◽  
Vol 16 (2) ◽  
pp. 14-17
Author(s):  
Mohammad Ahmed Ahsan ◽  
Md Fashiur Rahman ◽  
Umar Rashed Munir ◽  
Mushtaq Ahmad ◽  
Syeda Aleya Sultana
Keyword(s):  
Blood Pressure ◽  
Air Force ◽  
Left Ventricular ◽  
Target Organ ◽  
White Coat ◽  
Organ Involvement ◽  
White Coat Hypertension ◽  
Clinical Implications ◽  
Hypertensive Retinopathy

Introduction: When there is a difference of patient's blood pressure (BP) which is measured in a physician's office and patient’s home, it is said to have White Coat Hypertension (WCH). Prevalence of WCH is very much common among aircrew, because they need to face everyday preflight medical checkup. Objective: To find out the incidence of WCH among the aircrew of Bangladesh Air Force (BAF) as well as to ascertain the long-term clinical implications of WCH. Materials and Methods: This cross-sectional observational study was conducted among 150 aircrew, reported to Central Medical Board (CMB), Bangladesh Air Force (BAF) for periodical medical evaluation, during the period January 2014 to December 2018. Study subjects were selected purposively with age range 25-50 years; those who did not have any history of hypertension or received any anti-hypertensive medication but were detected elevated BP having clinical recording of BP ≥ 140/90 mm of Hg. Ambulatory blood pressure monitoring (ABPM) was performed on them for 24 hours in order to distinguish between those who were truly hypertensive and those who were suffering from WCH. To exclude secondary causes of hypertension as well as to assess for evidence of target organ damage (TOD), a thorough clinical and laboratory examination as well as regular follow-up were also performed. Results: White Coat Hypertension was observed in 26.7% of the aircrew. There was no evidence of target organ involvement, such as left ventricular dysfunction, left ventricular hypertrophy, hypertensive retinopathy or renal involvement. Conclusion: WCH is comparatively common among the aircrew. This highlights the importance of the requirement for regular follow up of all cases of WCH, over the normotensive subjects with a view to identify early organ involvement and therapeutic intervention are often initiated as and once needed. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 14-17

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