Abstract 409: Reproducibility of White Coat and Masked Hypertension Definitions One Year after the Diagnosis

Hypertension ◽  
2014 ◽  
Vol 64 (suppl_1) ◽  
Author(s):  
ALEJANDRO DE LA SIERRA ◽  
JOSE R BANEGAS ◽  
ERNEST VINYOLES ◽  
MANUEL GOROSTIDI ◽  
JULIAN SEGURA ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Antihypertensive Drugs ◽  
White Coat ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Specific Group ◽  
Clinical Pattern ◽  
Prevalence Of Obesity ◽  
One Year

A significant number of subjects present discordant results when BP is measured both at the clinic and by 24-hour ABPM. The aim of the study was to assess the reproducibility of a diagnosis of normotension (NT), white coat hypertension (WCH), masked hypertension (MH) and sustained hypertension (SH) in a cohort of untreated subjects who underwent a second ABPM without being treated with antihypertensive drugs. From the Spanish ABPM Registry, we selected 843 untreated subjects who underwent at least 2 BP examinations (both at the clinic and by ABPM) separated by 2 months or more (median,IQR: 13; 6-28 months), and who did not receive antihypertensive drug treatment in the period lasting between the 2 examinations. The 4 above mentioned categories were defined by normal (<140/90 mmHg) or elevated BP at the clinic (mean of 2 measurements), and by normal (<130/80 mmHg) or elevated 24-hour BP. At baseline, 140 (17%), 206 (25%), 78 (9%), and 414 (49%) had NT, WCH, MH, and SH, respectively. At the 2nd clinic and ABPM examination 52% of NT, 55% of WCH, 47% of MH, and 82% of SH fall into the same category. In both the WCH and MH categories, the most frequent switch was to SH (26% and 33%, respectively). When patients who changed or remained in the same category were compared, there were no differences in clinical variables, such as age, gender, or prevalence of obesity, diabetes, or previous cardiovascular disease. Both clinic and ambulatory BP were higher in patients who fall into the same category in both examinations, but this was driven by the higher reproducibility of SH. In the specific group of WCH (206 patients) there were no significant BP differences at baseline between the 114 who maintained such diagnosis, compared to the 54 patients who developed SH. Conversely, in the 78 patients with MH at baseline, those who developed SH at the 2nd examination (26) had higher levels of clinic diastolic BP (84±4 vs. 80±5 mmHg; p=0.006), compared with those who remained with MH (37). In conclusion, the diagnosis of SH is highly reproducible after one year of the first diagnosis. However, a diagnosis of WCH or MH requires a close follow-up, as almost 50% of patients do not show the same diagnosis and develop SH. There is no a specific clinical pattern which can be of help to predict which patients will develop SH.

scholarly journals White-coat hypertension and masked hypertension: an update

2015 ◽  
Vol 9 (3) ◽  
Author(s):  
Nathan Artom ◽  
Francesco Salvo ◽  
Francesca Camardella
Keyword(s):  
Cardiovascular Disease ◽  
White Coat ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Search Terms ◽  
Clinical Consequences ◽  
In The Beginning

White coat hypertension and masked hypertension are two conditions with a controversial role in the beginning and the progression of the cardiovascular disease. We focused our attention to the definition, the epidemiology, the pathophysiology and the clinical consequences of these two conditions, with an attention also to the management. This review was based on the papers found on PubMed and MEDLINE up to August 2015. The search terms used were <em>white coat hypertension</em>, <em>masked hypertension</em> in combination with <em>epidemiology, management and pathophysiology</em>.

scholarly journals Long-Term Risk of Progression to Sustained Hypertension in White-Coat Hypertension with Normal Night-Time Blood Pressure Values

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
João Faria ◽  
José Mesquita Bastos ◽  
Susana Bertoquini ◽  
José Silva ◽  
Jorge Polónia
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Drugs ◽  
White Coat ◽  
White Coat Hypertension ◽  
Night Time ◽  
Risk Of Progression ◽  
Daytime Blood Pressure ◽  
Long Term Prognosis

Background. The long-term prognosis and transition towards sustained ambulatory hypertension (SHT) of white-coat hypertension (WCHT) remain uncertain particularly in those with both normal nighttime and daytime blood pressure (BP) values. Different classification criteria and the use of antihypertensive drugs may contribute to conflicting results. Patients and Methods. We prospectively evaluated for a 7.1 year transition to SHT in 899 nondiabetic subjects free from cardiovascular (CV) events: normotensive (NT) (n = 344; 52, 9% female; ageing 48 ± 14 years); untreated WCHT (UnWCHT n = 399; 50, 1% female; ageing 51 ± 14 years); and treated WCHT with antihypertensive drugs after baseline (TxWCHT n = 156; 54, 4% female; ageing 51 ± 15 years). All underwent 24 h ambulatory BP monitoring (24 h-ABPM) at baseline, at 30 to 60 months, and at 70 to 120 months thereafter. WCHT was at baseline (with no treatment) as office BP ≥ 140/or 90 mm·Hg, daytime BP < 135/85 mm·Hg, and nighttime BP < 120/70 mm·Hg. Development of SHT was considered if daytime BP ≥ 135/or 85 mm Hg and/or nighttime BP ≥ 120/or 70 mm·Hg. Results. Baseline metabolic parameters did not differ among groups. At 30–60 months and at the end of follow-up, development of SHT occurred, respectively, in NT (3.8% (n = 13) and 9.6% (n = 33)) and in UnWCHT (10.1% (n = 40) and 16.5% (n = 66)) ( p < 0.009 ). The mean annual increase of average 24 h-systolic BP was 0.48 + 0.93 in NT and 0.73 + 1.06 in UnWCHT, whereas annual SBP in office increased in NT by 1.2 + 0.95 but decreased in UnWCHT by 1.36 + 1.35 mm Hg ( p < 0.01 ). Conclusion. Untreated WCHT patients exhibit a faster and a higher risk of developing SHT compared to NT with TxWCHT assuming an intermediate position between them.

scholarly journals Cardiovascular risk factors associated with acute myocardial infarction and stroke in the MADIABETES cohort

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
M. A. Salinero-Fort ◽  
F. J. San Andrés-Rebollo ◽  
J. Cárdenas-Valladolid ◽  
M. Méndez-Bailón ◽  
R. M. Chico-Moraleja ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Pressure ◽  
Antihypertensive Drugs ◽  
Hdl Cholesterol ◽  
First Year ◽  
Backward Elimination ◽  
One Year ◽  
Time Varying Covariates

AbstractWe aimed to develop two models to estimate first AMI and stroke/TIA, respectively, in type 2 diabetes mellitus patients, by applying backward elimination to the following variables: age, sex, duration of diabetes, smoking, BMI, and use of antihyperglycemic drugs, statins, and aspirin. As time-varying covariates, we analyzed blood pressure, albuminuria, lipid profile, HbA1c, retinopathy, neuropathy, and atrial fibrillation (only in stroke/TIA model). Both models were stratified by antihypertensive drugs. We evaluated 2980 patients (52.8% women; 67.3 ± 11.2 years) with 24,159 person-years of follow-up. We recorded 114 cases of AMI and 185 cases of stroke/TIA. The factors that were independently associated with first AMI were age (≥ 75 years vs. < 75 years) (p = 0.019), higher HbA1c (> 64 mmol/mol vs. < 53 mmol/mol) (p = 0.003), HDL-cholesterol (0.90–1.81 mmol/L vs. < 0.90 mmol/L) (p = 0.002), and diastolic blood pressure (65–85 mmHg vs. < 65 mmHg) (p < 0.001). The factors that were independently associated with first stroke/TIA were age (≥ 75 years vs. < 60 years) (p < 0.001), atrial fibrillation (first year after the diagnosis vs. more than one year) (p = 0.001), glomerular filtration rate (per each 15 mL/min/1.73 m2 decrease) (p < 0.001), total cholesterol (3.88–6.46 mmol/L vs. < 3.88 mmol/L) (p < 0.001), triglycerides (per each increment of 1.13 mmol/L) (p = 0.031), albuminuria (p < 0.001), neuropathy (p = 0.01), and retinopathy (p = 0.023).

MO501INCREASED ALBUMINURIA RISK IN CHRONIC KIDNEY DISEASE PATIENTS WHOSE WHITE COAT-, MASKED-, AND SUSTAINED HYPERTENSION: SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Boby Pratama Putra ◽  
Felix Nugraha Putra
Keyword(s):  
Meta Analysis ◽  
Blood Pressure Measurement ◽  
Target Organ Damage ◽  
Random Effect ◽  
White Coat ◽  
Cochrane Library ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Sustained Hypertension ◽  
Standard Mean Difference

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&lt;0.00001, I2 = 0%), MHT (SMD = 0.34, 95%CI 0.19 to 0.49, p&lt;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.

Abstract 11530: Age-Specific Differences Between Conventional and Ambulatory Daytime Blood Pressure Values

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
David Conen ◽  
Stefanie Aeschbacher ◽  
Lutgarde Thijs ◽  
Yan Li ◽  
José Boggia ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Population Based ◽  
White Coat ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Daytime Blood Pressure ◽  
Collaborative Analysis ◽  
The Individual ◽  
Age Range ◽  
Diagnosis Of Hypertension

Introduction: Mean daytime ambulatory blood pressure (ABP) values are considered to be lower than conventional BP (CBP) values, but data on this relation among younger individuals <50 years are scarce. To address this issue, we performed a collaborative analysis in a large group of participants representing a wide age range. Methods: CBP and 24-hour ABP were measured in 9550 individuals not taking BP lowering treatment from 13 population based cohorts. We compared the individual differences between daytime ABP and CBP according to 10-year age categories. Age-specific prevalences of white-coat hypertension and masked hypertension were calculated based on guideline-recommended thresholds. Results: Among individuals aged 18-30, 30-40 and 40-50 years, mean daytime systolic and diastolic ABP were significantly higher than the corresponding CBP (6.0, 5.2 and 4.7 mmHg for systolic BP; 2.5, 2.7 and 1.7 mmHg for diastolic BP, all p<0.0001) (Figure). Systolic and diastolic BP indices were similar in participants aged 50-60 years (p=0.20 and 0.11, respectively). In individuals aged 60-70 and ≥70 years, CBP was significantly higher than daytime ABP (5.0 and 13.0 mmHg for systolic BP; 2.0 and 4.2 mmHg for diastolic BP, all p<0.0001) (Figure). Accordingly, the prevalence of white coat hypertension exponentially increased from 2.2% to 19.5% from those aged 18-30 years to those aged ≥70 years, with some variation between men and women (prevalence 8.0% versus 6.1%, p=0.0003). Masked hypertension was more prevalent among men (21.1% versus 11.4%, p<0.0001). The age-specific prevalence of masked hypertension was 18.2%, 27.3%, 27.8%, 20.1% 13.6% and 10.2% in men, and 9.0%, 9.9%, 12.2%, 11.9%, 14.7% and 12.1% in women. Conclusions: In this large collaborative analysis we found that the relation between daytime ABP and CBP strongly varies by age. These findings may have important implications for the diagnosis of hypertension and its subtypes in clinical practice.

Follow-up of white-coat hypertension in the Hanshin-Awaji earthquake

The Lancet ◽  
1996 ◽  
Vol 347 (9001) ◽  
pp. 626-627 ◽  
Author(s):  
Kazuomi Kario ◽  
Takefumi Matsuo ◽  
Kazuyuki Shimada
Keyword(s):  
White Coat ◽  
White Coat Hypertension

Persistence with Antihypertensives Related to Formulation: The Case of Nifedipine

2005 ◽  
Vol 39 (2) ◽  
pp. 237-242 ◽  
Author(s):  
Nancy S Breekveldt-Postma ◽  
Ron MC Herings
Keyword(s):  
Cardiovascular Diseases ◽  
Antihypertensive Drugs ◽  
First Year ◽  
Proportional Hazard ◽  
Once Daily ◽  
Gastrointestinal Therapeutic System ◽  
Dosing Frequency ◽  
Nifedipine Gastrointestinal Therapeutic System ◽  
One Year

BACKGROUND: Controlled-release dosage forms may enhance persistence with therapy because of reduced dosing frequency and fewer adverse effects. OBJECTIVE: To assess the differences in persistent use of nifedipine between once-daily nifedipine gastrointestinal therapeutic system (GITS) and twice-daily nifedipine retard formulations. METHODS: Incident nifedipine users were selected from January 1992 to December 2001 from the PHARMO database, including drug-dispensing records and hospital records of more than one million subjects in the Netherlands. Patients with unaltered formulation and dosing frequency of nifedipine in the first year of follow-up with at least 2 prescriptions were included in the cohort. Persistence with different formulations was assessed using Cox's proportional hazard analyses. Covariates included in the analysis were, among others, hospitalizations and comedication for cardiovascular diseases. RESULTS: In total, 5889 incident users of nifedipine were included. The median duration of the first treatment episode was 133 days for nifedipine retard and 262 days for nifedipine GITS. One-year persistence with nifedipine increased from 32% in patients using retard formulations to 44% in patients using nifedipine GITS. Multivariate analyses showed that patients using nifedipine GITS were 1.3 times (RR 1.33; 95% CI 1.22 to 1.46) more persistent than those using retard formulations of nifedipine. Persistent patients more often used other antihypertensive drugs and were more often hospitalized for cardiovascular diseases. CONCLUSIONS: Patients using once-daily nifedipine GITS are more persistent with therapy than patients using twice-daily retard formulations.

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