RISK OF SUSTAINED HYPERTENSION IN MASKED AND WHITE-COAT HYPERTENSION: A FOLLOW-UP STUDY OF AN ELDERLY COMMUNITY-BASED COHORT

Abstract Background and Aims Latest classification of hypertension based on ambulatory blood pressure measurement was normotension (NT), white coat hypertension (WCHT), masked hypertension (MHT), and sustained hypertension (SHT). Recent studies suggest that WCHT, MHT, and SHT increase risk of target organ damage, particularly albuminuria, although the results were still inconsistent. Albuminuria is not only the sign of early glomerular damage in CKD patients, but also the signs of hypertension progression and predictors for cardiovascular events mortality. This study aims to compare the albuminuria risk among NT and WCHT, MHT, also SHT in CKD patients. Method We searched the literature comprehensively in online databases of Pubmed, EMBASE, ScienceDirect, and Cochrane Library to include all relevant studies using predefined terms until December 2020. We included studies that analyzed the albuminuria risk and compared the log2 urinary albumin-to-creatinine ratio (ACR) among NT and WCHT, MHT, or SHT in CKD patients. We used the Newcastle-Ottawa Scale for Observational Study checklist for evaluating bias risks. Analysis of the studies was conducted to provide pooled Odds Ratio (OR) for albuminuria risk and standard mean difference (SMD) for log2 ACR comparison with 95% Confidence Interval (CI) with random-effect heterogeneity test. Results We included 7 observational studies met our inclusion criteria. WCHT increases albuminuria risk although not statistically significant (pooled OR = 1.72, 95%CI 0.97 to 3.07, p = 0.06, I2 = 75%), while MHT and SHT significantly increase albuminuria risk with pooled OR respectively 1.62 (95%CI 1.03 to 2.53, p = 0.04, I2 = 82%) and 3.17 (95%CI 1.66 to 6.05, p = 0.0005, I2 = 94%). Controlled hypertension significantly protects CKD patients against albuminuria risk based on log2 ACR comparison with WCHT (SMD = 0.52, 95%CI 0.38 to 0.67, p<0.00001, I2 = 0%), MHT (SMD = 0.34, 95%CI 0.19 to 0.49, p<0.0001, I2 = 39%), and SHT (SMD = 0.63, 95%CI 0.31 to 0.95, p=0.0001, I2 = 76%). Conclusion White coat hypertension, masked hypertension, and sustained hypertension increase albuminuria risks in CKD patients. However, further studies are needed to determine the causality.

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A follow-up study observing health outcomes of the care recipients in the home and community-based service of the long-term care system of Taiwan

Health and Primary Care ◽

10.15761/hpc.1000118 ◽

2017 ◽

Vol 1 (3) ◽

Author(s):

Li-Fan Liu ◽

Nai-Wen Guo ◽

Pei-Fang Su ◽

Jia-Jen Chen

Keyword(s):

Health Outcomes ◽

Long Term Care ◽

Community Based ◽

Term Care ◽

Follow Up Study ◽

Care Recipients ◽

Care System

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Abstract 2745: Diagnostic Algorithm Using Office and Home Blood Pressures to Exclude White Coat Hypertension

Circulation ◽

10.1161/circ.116.suppl_16.ii_609-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Sujith Kuruvilla ◽

Kiran Nallella ◽

Anne Mani ◽

Geetha Pinto ◽

Daichi Shimbo ◽

...

Keyword(s):

Blood Pressure ◽

Sensitivity And Specificity ◽

Diagnostic Algorithm ◽

White Coat ◽

White Coat Hypertension ◽

Clinic Blood Pressure ◽

Cutoff Value ◽

Sustained Hypertension ◽

Traditional Algorithm ◽

Blood Pressures

Background: It has been suggested that the diagnosis of sustained hypertension (SHTN), defined as clinic blood pressure (CBP) ≥140 or ≥90 mmHg plus a daytime ambulatory BP (ABP) ≥135 or ≥85 mmHg can be optimized by taking home BP (HBP) in those with high CBP, and obtaining ABP only if HBP is normal (<135/85). This study tested whether a higher cutoff value for CBP using Receiver Operator Curves (ROC) based on systolic and diastolic CBP for the diagnosis of SHT (95% specificity) would improve the efficiency of the algorithm for diagnosing SHT and reduce the number of subjects requiring HBP and ABP to establish the diagnosis. Methods and Results: We assessed CBP, ABP and HBP in 229 normotensive and untreated hypertensive subjects. CBP was high in 84 subjects. Of these, 74 (88%) had SHTN, and 10 (12%) white coat HTN (WCH- high CBP but normal ABP). With HBP, 69 (82%) had high HBP, and of these 63 (91%) had SHT. Based on traditional algorithm, 15 subjects require ABP monitoring to diagnose SHT, which would be confirmed in 11. Using the ROC algorithm, 55 of 84 subjects (50 SHT; 5 WCH) would be classified as ``hypertensive” (at or above the CBP cut-off); 29 subjects would fall below the cut-off and require HBP (with 24 having SHT); 5 subjects would require ABP. The sensitivity and specificity for diagnosing SHT were 100% and 40% for the traditional algorithm, and 100% and 20% for the ROC algorithm. Conclusions: The ROC algorithm is as effective as the traditional algorithm for diagnosing SHT, and requires fewer HBPs (29 vs. 84) and ABPs (5 vs. 15). Therefore, this algorithm may have widespread indications for the screening of ambulatory hypertension.

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