scholarly journals Impact of 2018 ESC/ESH and 2017 ACC/AHA Hypertension Guidelines: Difference in Prevalence of White-Coat and Masked Hypertension

Healthcare ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 122
Author(s):  
Byong-Kyu Kim ◽  
Moo-Yong Rhee
Keyword(s):  
Blood Pressure ◽  
White Coat ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Clinic Blood Pressure ◽  
Hypertension Guidelines ◽  
Diagnostic Threshold ◽  
High Prevalence ◽  
Drug History ◽  
Research Grade

Our study evaluated whether there were differences in the prevalence of white-coat hypertension (WH) and masked hypertension (MH) based on the 2018 ESC/ESH and 2017 ACC/AHA hypertension guidelines in Korea. The motivation was the lowering of the diagnostic threshold for hypertension in the 2017 ACC/AHA guidelines. Of 319 participants without antihypertensive drug history and with suspected hypertension based on outpatient clinic blood pressure (BP) measured by physicians, 263 participants (51.6 ± 9.6 years; 125 men) who had valid research-grade office BP and 24-h ambulatory BP measurements were enrolled. WH prevalence based on daytime ambulatory BP among normotensive individuals was lower with the ESC/ESH guidelines than the ACC/AHA guidelines (29.0% vs. 71.4%, p < 0.001). However, MH prevalence based on daytime ambulatory BP among hypertensive individuals was higher based on the ESC/ESH guidelines (21.6% vs. 1.8%, p < 0.001). Seventy percent of WH cases (2017 ACC/AHA guidelines) and 95.2% of MH cases (2018 ESC/ESH guidelines) occurred in individuals with systolic BP of 130–139 mmHg and/or diastolic BP of 80–89 mmHg. The diagnostic threshold of the 2017 ACC/AHA guidelines yielded a higher prevalence of WH compared to that of the 2018 ESC/ESH guidelines. However, the prevalence of MH was higher with the 2018 ESC/ESH guidelines than with the 2017 ACC/AHA guidelines. The high prevalence of WH and MH in people with a systolic BP of 130–139 mmHg or diastolic BP of 80–89 mmHg suggests the need for a more active out-of-office BP measurement in this patient group.

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.

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

Circulation ◽  
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.

P0149PREVALENCE OF MASKED HYPERTENSION IN HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ekaterina Borodulina ◽  
Alexander M Shutov
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
Home Blood Pressure ◽  
Office Blood Pressure ◽  
White Coat ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Pressure Measurements

Abstract Background and Aims Arterial hypertension is main cause of left ventricular hypertrophy (LVH) in hemodialysis patients. Masked hypertension is associated with asymptomatic organ damage, including the development of LVH. The aim of this study was to investigate the prevalence of white-coat hypertension and masked hypertension in hemodialysis patients. Method Hemodialysis patients (n=88; 42 males, 46 females, mean age was 51.7±13.3 years) were studied. Office blood pressure measurements were performed before and after hemodialysis within 30 days. Home Blood Pressure Measurements (HBPM) was collected in the morning and in the evening during 4 weeks including hemodialysis session days. 24 hours blood pressure monitoring (ABPM) was performed in the next day after hemodialysis. Systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP) were analyzed. White-coat hypertension was diagnosed when blood pressure elevated in the office, but was normal when was measured by ABPM, HBPM, or both. Masked hypertension was determined when blood pressure was normal in the office, but increased when was measured by HBPM or ABPM. The definitions of the European Society of Cardiology (2018 ESC/ESH Guidelines for the management of arterial hypertension) were used for the diagnosis of hypertension according to office, ambulatory, and home blood pressure levels. Echocardiographic evaluation was performed on the day after dialysis and left ventricular mass index (LVMI) was calculated. Results Arterial hypertension was diagnosed by office blood pressure measurements in 39 (44.3%) patients. Arterial hypertension was defined by ABPM (mean 24h BP &gt; or = 130 and 80 mmHg) in 48 (54.5%) patients. The number of non-dipper patients was 59 (67.0%). According to HBPM arterial hypertension was observed in 61 (69.3%) patients. Left ventricular hypertrophy was detected in 71 (80.7%) patients. Mean LVMI was 140.5±43.0 g/m2. According to the results of three methods of blood pressure measuring arterial hypertension was diagnosed in 53 (60.2%) patients, white-coat hypertension was observed in 5 (5.7%) patients, masked hypertension – in 19 (21.6%) patients. Conclusion According to office blood pressure measurements arterial hypertension was diagnosed in 44.3% hemodialysis patients. Masked hypertension was often observed in hemodialysis patients and when using not only ABPM, but also HBPM was detected in 21.6% of patients. The results indicate the importance of using not only ABPM, but also HBPM in hemodialysis patients.

THE DIAGNOSTIC THRESHOLD OF 2017 ACC/AHA HYPERTENSION GUIDELINES INCREASES WHITE-COAT HYPERTENSION

2018 ◽  
Vol 36 (Supplement 1) ◽  
pp. e73
Author(s):  
M.Y. Rhee ◽  
J.H. Kim ◽  
J. Namgung ◽  
S.Y. Lee ◽  
D.K. Cho ◽  
...  
Keyword(s):  
White Coat ◽  
White Coat Hypertension ◽  
Hypertension Guidelines ◽  
Diagnostic Threshold

scholarly journals Non-Clinic Blood Pressure Measurement – More Light, Less Darkness

2018 ◽  
Vol 10 (1) ◽  
pp. 13-18
Author(s):  
Vinay Kapur
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Measurement ◽  
Target Organ Damage ◽  
Early Morning ◽  
Morbidity And Mortality ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Clinic Blood Pressure ◽  
Night Time ◽  
Nocturnal Hypertension

Non-clinic blood pressure measurements are very important in confirming diagnosis of hypertension and they give us an idea of associated cardiovascular risk more precisely than clinic BP measurements. It can detect masked hypertension and white coat hypertension & ABPM especially can monitor night-time BP diagnosing individuals with nocturnal hypertension.  Masked hypertension and nocturnal hypertension are strongly related with target organ damage along with enhanced morbidity and mortality due to cardiovascular causes. ABPM can also measure early morning rise of BP, mean 24 hour BP, diurnal variation as well as average real variability. Home BP monitoring by patients themselves leads to their greater involvement in maintaining BP records and in achieving treatment goals. The purpose of this review is to preferentially discuss role of non-clinic BP monitoring in making accurate diagnosis and deciding treatment of hypertension that might help a great deal in reducing morbidity and mortality associated with it.        Asian Journal of Medical Sciences Vol.10(1) 2019 13-18 

Prevalence and Determinants of Masked Hypertension in Nigeria: The REMAH Study

2020 ◽  
Author(s):  
Augustine N ODILI ◽  
Benjamin DANLADI ◽  
Babangida S CHORI ◽  
Henry OSHAJU ◽  
Peter C NWAKILE ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Blood Glucose ◽  
Confidence Interval ◽  
White Coat Hypertension ◽  
Masked Hypertension ◽  
Clinic Blood Pressure ◽  
Random Blood Glucose ◽  
Oscillometric Device ◽  
Nationally Representative

Abstract Background Estimating the burden of hypertension in Nigeria hitherto relied on clinic blood pressure (BP) measurement alone. This excludes individuals with masked hypertension (MH) i.e. normotensive clinic but hypertensive out-of-clinic BP. Method In a nationally representative sample of adult Nigerians, we obtained clinic BP using auscultatory method and out-of-clinic BP by self-measured home BP with semi-automated oscillometric device. Clinic BP was average of 5 consecutive measurements and home BP was average of 3 days duplicate morning and evening readings. MH was clinic BP &lt; 140 mmHg systolic and 90 mmHg diastolic and home BP ≥ 135 mmHg systolic and/or 85 mmHg diastolic. Result Among 933 participants, the prevalence of sustained, masked and white-coat hypertension was 28.3, 7.9 and 11.9 % respectively. Among subjects whose clinic BP were in the normotensive range (n=558), the prevalence of MH was 13%; 12% among untreated and 27% among treated individuals. The mutually adjusted odds ratios of having MH among all participants with normotensive clinic BP were 1.33 (95% confidence interval, 1.10–1.60) for a 10-year higher age, 1.59 (1.09–2.40) for a 10 mm Hg increment in systolic clinic BP, and 1.16 (1.08–1.28) for a 10mg/dl higher random blood glucose. The corresponding estimates in the untreated population were 1.24 (1.03–1.51), 1.56 (1.04–2.44) and 1.16 (1.08– 1.29), respectively. Conclusion MH is common in Nigeria and increasing age, clinic systolic BP and random blood glucose are the risk factors.

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