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

Conen, David; Aeschbacher, Stefanie; Thijs, Lutgarde; Li, Yan; Boggia, José; Asayama, Kei; Hansen, Tine W.; Kikuya, Masahiro; Björklund-Bodegård, Kristina; Ohkubo, Takayoshi; Jeppesen, Jørgen; Gu, Yuxuan; Torp‐Pedersen, Christian; Dolan, Eamon; Kuznetsova, Tatiana; Stolarz‐Skrzypek, Katarzyna; Tikhonoff, Valérie; Schoen, Tobias; Malyutina, Sofia; Casíglia, Edoardo; Nikitin, Yu. P.; Lind, Lars; Sandoya, Edgardo; Kawecka‐Jaszcz, Kalina; Mena, Luis J.; Maestre, Gladys E.; Filipovský, Jan; Imai, Yutaka; O’Brien, Eoin; Wang, Tzung‐Dau; Risch, L.; Staessen, Jan A.

doi:10.1161/hypertensionaha.114.03957

Cited by 81 publications

(68 citation statements)

References 26 publications

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“…At variance with prior studies, [14][15][16]27 we did not find significant changes in the direction of the mean BP differences between clinic and ambulatory BP values at any particular age, even in untreated patients. In other words, these BP differences were generally positive, that is, higher clinic than daytime ABPM values across all age groups.…”

Section: Comparison With Other Studiescontrasting

confidence: 89%

“…5,8 More recently, a meta-analysis of population studies on adults and children performed in 1990 to 2009 and a recent study from the IDACO (International Database on Ambulatory Blood Pressure and Cardiovascular Outcomes) on 13 population-based cohorts have described higher clinic than daytime BP only in older subjects, but higher daytime than clinic BP in subjects under the age of 50 years. 14,15 Similar results (daytime BP higher than clinic BP) have been described in children and adolescents. 16,17 Most of these previous studies were centered on untreated populations, 5,14,15 and most prior clinical studies have been small (<200 subjects).…”

Section: Hypertensionsupporting

confidence: 75%

“…14,15 Similar results (daytime BP higher than clinic BP) have been described in children and adolescents. 16,17 Most of these previous studies were centered on untreated populations, 5,14,15 and most prior clinical studies have been small (<200 subjects). [6][7][8][9]11 Thus, little is known about the age relationship between clinic and ambulatory BP in large cohorts of hypertensive patients in usual clinical practice, especially in primary care, where most treated and untreated hypertensive people are cared for.…”

Section: Hypertensionsupporting

confidence: 75%

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Clinic Versus Daytime Ambulatory Blood Pressure Difference in Hypertensive Patients

et al. 2017

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C onventional blood pressure (BP) determined in the clinic has been the standard of defining BP status for many decades.1 However, out-of-clinic BP (eg, ambulatory BP monitoring [ABPM]) can provide a more accurate estimate of the true BP and better predict clinical outcomes than conventional BP.1-3 The Framingham Heart Study showed that clinic systolic BP (SBP) rises from adolescence through most of adulthood. 4 In contrast, diastolic BP (DBP) initially increases in young adulthood, levels off at age 50 to 55 years, and then usually decreases after age 60 to 65. BP trajectories obtained using ABPM also increase with age, but the age gradients are less steep than those from conventional BP. 5 It has long been reported that seated clinic BP is usually higher than daytime ambulatory or home-measured BP, mostly in hypertensive patients. [5][6][7][8][9][10][11] The difference in clinic-ambulatory BP values has been used to quantify the so-called whitecoat effect (WCE), which has been related, at least in part, to the alert reaction and transient increase in BP that often occurs during the clinic visit.12,13 Some studies have reported that the clinic-daytime BP differences increase progressively both Abstract-Clinic blood pressure (BP) is usually higher than daytime ambulatory BP in hypertensive patients, but some recent studies have challenged this view, suggesting that this relationship is strongly influenced by age. We used the Spanish ambulatory BP monitoring cohort to examine differences between clinic and daytime BP by age among 104 639 adult hypertensive patients (office systolic/diastolic BP ≥140/90 mm Hg or treated) in usual primary-care practice, across the wide age spectrum. To assess the impact of age, cardiovascular variables, and clinic BP on the clinic-daytime BP differences, we built multivariable regression models of the average BP differences, white-coat hypertension (high clinic BP and normal daytime BP), and masked hypertension (normal clinic BP and high daytime BP). In most patients, mean clinic BP values were higher than daytime BP at all ages. Some 36.7% of patients had white-coat hypertension (amounting to 50% at clinic systolic BP of 140-159 mm Hg) and 3.9% had masked hypertension (amounting to 18% at clinic systolic BP of 130-139 mm Hg). Age explained 0.1% to 1.7% of the variance of quantitative or categorical BP differences (P<0.001). Cardiovascular variables explained an additional 1.6% to 3.4% of the variance (P<0.001). Finally, clinic BP generally explained ≥20% more of the variance (P<0.01). In this large study in usual clinical practice, clinic BP misclassified hypertension status in >40% of patients. This misclassification was not importantly influenced by age but was more evident in patients with borderline/grade 1 hypertension. These findings reinforce the importance of ambulatory BP monitoring for defining BP status in routine clinical practice. (Hypertension. 2017;69:211-219.

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Section: Comparison With Other Studiescontrasting

confidence: 89%

Section: Hypertensionsupporting

confidence: 75%

Section: Hypertensionsupporting

confidence: 75%

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Clinic Versus Daytime Ambulatory Blood Pressure Difference in Hypertensive Patients

et al. 2017

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“…Single-drug therapy reduced Relevant 2° endpoint: Active treatment also reduced the risk of total major vascular events (26% [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]). There were similar reductions in the risk of stroke in hypertensive and nonhypertensive subgroups (all p<0.01).…”

Section: Key Findingsmentioning

confidence: 99%

2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Whelton¹,

Carey²,

Aronow³

et al. 2018

Hypertension

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“…Conen and colleagues 18 recently demonstrated that the prevalence of WCHT exponentially increased from 2.2% to 19.5% from those aged 18 to 30 years to those aged ≥70 years. WCHT is also more prevalent among female gender.…”

mentioning

confidence: 99%

White-coat hypertension and masked hypertension: an update

2015

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The precise quantification of blood pressure (BP) is an essential step to reach the largest number of correct diagnosis of arterial hypertension (AH) and consequently to optimize the anti-hypertensive therapy. Since the invention of the first sphygmomanometer in 1896, Riva-Rocci observed the inaccuracy of that method for a correct BP determination: 1 the simple appearance of a doctor was accompanied by an immediate rise in BP in some patients. Years later Pickering called this phenomenon white coat hypertension (WCHT). 2 The introduction of fully-automated BP measurement during the 24 h (ambulatory blood pressure monitoring, ABPM) allowed to observe the entire circadian BP profile, highlighting how BP could be normal in physician office and elevated at home, especially during the nocturnal period. 3 This last observation was named masked hypertension (MHT). 4 WCHT is defined as office BP persistently ≥140 mmHg systolic, ≥90 mmHG diastolic, or both, whereas out-of-office BP is within normal (<130/80 mmHg for 24-h mean BP, or <135/85 mmHG for home BP). 5-7 Medical environment triggers this alarm reaction, 8 through the hyperactivation of sympathetic nervous system. 9 It peaked 2-4 min after the start of the visit and continued throughout the duration of the physician's visit. 10 For this reason, international guidelines recommended to record at least two ABPM to confirm the diagnosis of WCHT and to determine the possible development of sustained hypertension. 11 Further WCHT can be divided into true WCH, when both home BP values and ABPM values are normal, and partial WCHT, when only one of these out-of-office measurements is normal. 5 If WCHT can determinate an overdiagnosis of AH, on the other hand some subjects present normal office BP values in contrast to pathological 24-h BP profile on ABPM or altered home BP. This reverse white-coat effect or MHT 12,13 is related to a worse cardiovascular (CV) prognosis 14 and also to the development of a target organ damage (TOD) comparable to sustained hypertension patients 15 (Table 1). Both WCHT and MHT are examples of how the correct evaluation of BP profile is a difficult challenge and how their better knowledge can lead to a more precise diagnosis and consequently to a proper treatment of AH. EpidemiologyThe prevalence of WCHT and MHT is not completely clear. AS a confounding factor several studies showed different values for normal BP. Regarding White-coat hypertension and masked hypertension: an update ABSTRACTWhite 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 on the definition, the epidemiology, the pathophysiology and the clinical consequences of these two conditions, with an attention also on the management. This review was based on the papers found on PubMed and MEDLINE up to August 2015. The search terms used were white coat hypertension, masked hypertension in combination with epidemiology, management and pathophysiology.

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

Cited by 81 publications

References 26 publications

Clinic Versus Daytime Ambulatory Blood Pressure Difference in Hypertensive Patients

Clinic Versus Daytime Ambulatory Blood Pressure Difference in Hypertensive Patients

2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

White-coat hypertension and masked hypertension: an update

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