scholarly journals Is there a need to redo many of the diagnoses of hypertension?

2012 ◽  
Vol 130 (3) ◽  
pp. 173-178
Author(s):  
José Marcos Thalenberg ◽  
Bráulio Luna Filho ◽  
Maria Teresa Nogueira Bombig ◽  
Yoná Afonso Francisco ◽  
Rui Manuel dos Santos Póvoa
Keyword(s):  
Blood Pressure ◽  
Drug Withdrawal ◽  
Blood Pressure Monitoring ◽  
Target Organ Damage ◽  
Diagnostic Procedures ◽  
White Coat ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Cross Sectional ◽  
Clinical Measurements

CONTEXT AND OBJECTIVE: Most hypertensive subjects undergoing treatment were diagnosed solely through measurements made in the consultation office. The objective of this study was to redo the diagnosis of treated patients after new clinical measurements and ambulatory blood pressure monitoring (ABPM). DESIGN AND SETTING: Cross-sectional study conducted in an outpatient specialty clinic. METHODS: Patients with mild-to-moderate hypertension or undergoing anti-hypertensive treatment, without target organ damage or diabetes, were included. After drug withdrawal lasting 2-3 weeks, new blood pressure (BP) measurements were made during two separate visits. ABPM was performed blindly, in relation to clinical measurements. The BP thresholds used for diagnosing hypertension, white-coat hypertension, normotension and masked hypertension were: 140 (systolic) and 90 (diastolic) mmHg for office measurements and 135 (systolic) and 85 (diastolic) mmHg for mean awake ABPM (MAA). RESULTS: Evaluations were done on 101 subjects (70% women); mean age 51 ± 10 years. The clinical BP was 155 ± 18/97 ± 10 mmHg (first visit) and 150 ± 16/94 ± 11 mmHg (second visit); MAA was 137 ± 13/ 86 ± 10 mmHg. Sixty-four patients (63%) were confirmed as hypertensive, 28 (28%) as white-coat hypertensive, nine (9%) as normotensive and none as masked hypertensive. After ABPM, 37% of the presumed hypertensive patients did not fit into this category. CONCLUSION: This study showed that hypertension was overdiagnosed among hypertensive subjects undergoing treatment. New diagnostic procedures should be performed after drug withdrawal, with the aid of BP monitoring.

scholarly journals White coat hypertension: current state of the issue

2021 ◽  
Vol 28 (2) ◽  
pp. 71-78
Author(s):  
K. H. Uvarova
Keyword(s):  
Blood Pressure ◽  
Antihypertensive Treatment ◽  
Blood Pressure Monitoring ◽  
Target Organ Damage ◽  
Prognostic Significance ◽  
Home Blood Pressure ◽  
White Coat ◽  
White Coat Hypertension ◽  
Lifestyle Modifications ◽  
Cardiovascular Morbidity And Mortality

More than 30 years have passed since the first description of such a concept as white coat hypertension was presented in the scientific literature, but since then, scientists are paying more and more attention to this condition. White coat hypertension is defined when the blood pressure readings obtained in the doctor’s office meet the criteria for hypertension, but the latter is not confirmed by outpatient or home blood pressure monitoring. Initially, the term was only applied to patients who had not received antihypertensive treatment, but recently this definition has been extended to people who regularly take drugs for lowering blood pressure, and this condition was called uncontrolled white coat hypertension. Some of the world’s most influential organizations in the field of cardiology have not reached a consensus on the definition of white coat hypertension on the background of common criteria, which has affected the differences in blood pressure thresholds according to outpatient monitoring. Quite a few studies in recent years have examined the clinical and prognostic significance of white coat hypertension in terms of its probable effects such as metabolic disorders, subclinical and extracardiac target organ damage, cardiovascular morbidity and mortality, and all-cause mortality. At present, there is no doubt that white coat hypertension is not an innocent condition; however, hypotheses about the prognostic role of this condition and the management of patients with white coat hypertension are still controversial. The question of treating white coat hypertension as a condition remains unsolved and requires further investigation. Today, it is considered most appropriate not to prescribe antihypertensive treatment to persons with office blood pressure at normal or below target levels, but to intensify lifestyle modifications and focus on reduction of cardiovascular risk.

scholarly journals High blood pressure and syncope: orthostatic hypotension as a link

2016 ◽  
Vol 84 (1-2) ◽  
Author(s):  
Martina Rafanelli ◽  
Andrea Ungar
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Blood Pressure Monitoring ◽  
Cognitive Status ◽  
White Coat ◽  
White Coat Hypertension ◽  
Blood Pressure Target ◽  
Masked Hypertension ◽  
Frailty Phenotype ◽  
The Relationship

<p>The prevalence of hypertension increases with the age. Diagnostic criteria are the same as for the young, but in older adults isolated systolic hypertension is more frequent, due to loss of vascular compliance. Blood pressure should be measured on both sides in the seated position, moreover in the supine and upright position to detect orthostatic hypotension. Ambulatory blood pressure monitoring is useful to detect white coat hypertension and masked hypertension, to tailor the treatment and search for diurnal and nocturnal blood pressure pattern abnormalities. Given that frailty can affect the relationship between blood pressure and mortality, the clinician should properly evaluate and monitor physical performance and cognitive status, throughout specific tools, as the Fried Frailty Phenotype, aiming at a systolic blood pressure target between 130 and 150 mmHg. Before starting hypotensive drugs, a careful risk and benefits’ evaluation should be performed given the high risk of hypertension and hypotension consequences and the frequent coexistence of orthostatic hypotension, which predisposes to syncope and falls.</p><p> </p><p> </p><p><strong>Riassunto</strong></p><p>La prevalenza dell’ipertensione arteriosa aumenta con l’età. I criteri diagnostici sono gli stessi previsti nel giovane, nell’anziano tuttavia si osserva più frequentemente ipertensione sistolica isolata, dovuta a perdita dell’elasticità vascolare. Ai fini diagnostici, la misurazione della pressione arteriosa bilateralmente in posizione seduta, deve essere integrata con la ricerca di ipotensione ortostatica. Il monitoraggio della pressione arteriosa nelle 24h è indicato per la conferma diagnostica, per la ricerca di “white coat hypertension” e “masked hypertension”, per monitorare la risposta terapeutica e ricercare alterazioni del ritmo circadiano. I benefici della terapia antiipertensiva sono noti, tuttavia un trattamento troppo aggressivo si è dimostrato dannoso, rendendo la gestione dell’ipertensione arteriosa nell’anziano ancora più complessa. Data l’influenza della fragilità sulla relazione tra pressione arteriosa e mortalità, il clinico dovrebbe avvalersi di adeguati strumenti per la definizione di performance fisica e cognitiva ed il monitoraggio nel tempo, mirando ad un target di pressione arteriosa sistolica compreso tra 130 e 150 mmHg. Rischi e benefici della terapia antiipertensiva dovrebbero essere attentamente valutati prima di intraprendere un trattamento, data la possibilità di eventi correlati sia all’ipertensione che all’ipotensione e la frequente coesistenza di ipotensione ortostatica, che incrementa il rischio di eventi sincopali e cadute. Nell’anziano iperteso con storia di sincope e cadute il trattamento dovrebbe quindi essere intrapreso una volta confermata la diagnosi, mirando ad un target pressorio più contenuto e con una scelta ponderata dei principi attivi.</p>

scholarly journals Clinical applications for out-of-office blood pressure monitoring

2020 ◽  
Vol 11 ◽  
pp. 204062232090166 ◽  
Author(s):  
Hailan Zhu ◽  
Haoxiao Zheng ◽  
Xinyue Liu ◽  
Weiyi Mai ◽  
Yuli Huang
Keyword(s):  
Blood Pressure ◽  
Clinical Studies ◽  
Blood Pressure Monitoring ◽  
Target Organ Damage ◽  
Epidemiological Data ◽  
Organ Damage ◽  
Home Blood Pressure ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Pressure Monitoring

Hypertension is one of the most common chronic diseases as well as the leading risk factor for cardiovascular disease (CVD). Efficient screening and accurate blood pressure (BP) monitoring are the basic methods of detection and management. However, with developments in electronic technology, BP measurement and monitoring are no longer limited to the physician’s office. Epidemiological and clinical studies have documented strong evidence for the efficacy of out-of-office BP monitoring in multiple fields for managing hypertension and CVD. This review discusses applications for out-of-office BP monitoring, including home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM), based on recent epidemiological data and clinical studies regarding the following factors: the detection of abnormal BP phenotypes, namely, white coat hypertension and masked hypertension; stronger ability to determine the prognosis for target organ damage and mortality; better BP control; screening for hypotension; and unique approaches to identifying circadian BP patterns and BP variability.

Prevalence and risk factors of white-coat hypertension and masked hypertension in Shunde District,Southern China:Observational Study (Preprint)

2021 ◽  
Author(s):  
Yuli Huang ◽  
Haoxiao Zheng ◽  
Xiaoyan Liang ◽  
Chunyi Huang ◽  
Lichang Sun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Family History ◽  
Blood Pressure Monitoring ◽  
Home Blood Pressure ◽  
White Coat ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Pressure Monitoring ◽  
History Of

BACKGROUND White-coat hypertension (WCH) and masked hypertension (MH) can increase the risk of target organ damage. Home blood pressure monitoring is an important method for detecting WCH and MH. However, the prevalence and risk factors of WCH and MH in China has been rarely reported. OBJECTIVE To explore the prevalence and risk factors associated with white coat hypertension (WCH) and masked hypertension (MH) in Shunde District, Southern China. METHODS This study recruited subjects from the Physical Examination Center in Shunde Hospital, Southern Medical University. Office blood pressure and home blood pressure values were collected. The prevalence of WCH and MH was calculated by combining the office blood pressure and home blood pressure values. Multivariate logistic regression was used to explore the related risk factors for WCH and MH. RESULTS Four-hundred and sixty-one participants (61% male), with an average age of 49 years, were included. The incidence of WCH and MH was 5.1% and 15.2%, respectively. Multivariate logistic regression analysis showed that smoking (OR=4.71, 95%CI=1.05-21.15) and family history of coronary heart disease (OR=4.51, 95%CI=1.08-18.93) were associated with higher odds of WCH. The associated factors for higher odds of MH were smoking (OR=2.83, 95%CI=1.11-7.23), family history of hypertension (OR=2.17, 95%CI=1.11-4.26) and family history of coronary heart disease (OR=2.82, 95%CI=1.07-7.45). CONCLUSIONS WCH and MH are highly prevalent in the health check-up population in Southern China. Out-of-office blood pressure monitoring, especially home blood pressure monitoring with a telemedicine device should be recommended to identity abnormal BP phenotype. CLINICALTRIAL It has been registered in the Chinese Clinical Trial Registry(ChiCTR1800018515)

Abstract P206: Ambulatory Blood Pressure Monitoring Phenotypes Among Individuals With and Without Diabetes: The Jackson Heart Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Samantha G Bromfield ◽  
Daichi Shimbo ◽  
Alain Bertoni ◽  
Mario Sims ◽  
April P Carson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ambulatory Blood Pressure Monitoring ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Prevalence Ratio ◽  
White Coat ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Pressure Monitoring ◽  
Heart Study

Several ambulatory blood pressure monitoring (ABPM) phenotypes including masked hypertension are associated with an increased risk for cardiovascular disease (CVD). Diabetes is associated with CVD risk as well as a higher prevalence of hypertension. However, little is known about whether ABPM phenotypes differ between individuals with versus without diabetes. We evaluated the association between diabetes and ABPM phenotypes including clinic hypertension, awake hypertension, sustained hypertension, nocturnal hypertension, non-dipping pattern, white coat hypertension, and masked hypertension in the Jackson Heart Study (JHS). Baseline data collection included two clinic blood pressure measurements using standardized protocols. ABPM measurements were taken in the 24 hours following the baseline visit. Diabetes was defined as fasting glucose ≥126 mg/dL, hemoglobin A1c ≥6.5%, or use of diabetes medications. Of the 1,032 JHS participants with valid ABPM data (67.7% female, mean age 59.2 years), 253 (24.5%) had diabetes. The prevalence of clinic hypertension was similar for participants with and without diabetes (Table 1). After multivariable adjustment, diabetes was associated with an increased prevalence ratio of awake, sustained, and masked hypertension and a lower prevalence ratio of white coat hypertension compared with individuals without diabetes. In summary, there was an increased prevalence of adverse blood pressure phenotypes among individuals with versus those without diabetes that was not captured in the clinic setting alone. The role of ABPM for identifying high risk individuals with diabetes should be further investigated.

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