Arterial distensibility in subjects with white-coat hypertension with and without diabetes or dyslipidaemia: comparison with normotensives and sustained hypertensives

Ribeiro, Laura; Gama, Guilherme; Santos, Alejandro; Asmar, Roland; Martins, Luís; Polónia, Jorge

doi:10.1097/00126097-200002000-00003

Cited by 23 publications

(20 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This could mean that their greater rate of progression to SHT depends at least in part to a more pronounced stiffening of the large arteries. 4,20 Finally, previous studies have shown that the size of nocturnal hypotension independently predicts the incidence of CV morbid and fatal events 17,21,22 and that this is the case also for BP variability. 17,23 However, in our subjects, these measures did not independently predict new-onset SHT, which means that their adverse prognostic significance is because of factors other than a more frequent worsening of the initial BP values.…”

Section: Mancia Et Al Risk Of Developing Sustained Hypertensionmentioning

confidence: 88%

“…[1][2][3] This is because in white-coat and masked hypertensive individuals, the prevalence of structural organ damage has not invariably been found to be greater than in "truly" normotensive individuals. [3][4][5][6][7] It is also because the longitudinal studies that have addressed this issue by assessing the incidence of morbidity and mortality have been based on a small number of CV events and/or a relatively short observation period. 8 -14 Information on the clinical significance of WCHT and MHT can also be obtained by investigating whether, compared with "true" normotension, these conditions are accompanied by a greater rate of development of a "sustained" hypertensive state, ie, HT both in and outside the clinical environment.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Long-Term Risk of Sustained Hypertension in White-Coat or Masked Hypertension

Mancia¹,

Bombelli²,

Facchetti³

et al. 2009

Hypertension

265

178

View full text Add to dashboard Cite

Abstract-It is debated whether white-coat (WCHT) and masked hypertension (MHT) are at greater risk of developing a sustained hypertensive state (SHT). In 1412 subjects of the Pressioni Arteriose Monitorate e Loro Associazioni Study, we measured office blood pressure (BP), 24-hour ambulatory BP, and home BP. Key Words: masked hypertension Ⅲ white-coat hypertension Ⅲ ambulatory blood pressure monitoring Ⅲ prognosis N o conclusive evidence exists as to whether isolated office or white-coat hypertension (HT; WCHT) and masked HT (MHT), ie, the conditions in which, respectively, only office or out-of-office blood pressure (BP) is elevated, are clinically innocent or rather associated with an increase in cardiovascular (CV) risk. [1][2][3] This is because in white-coat and masked hypertensive individuals, the prevalence of structural organ damage has not invariably been found to be greater than in "truly" normotensive individuals. [3][4][5][6][7] It is also because the longitudinal studies that have addressed this issue by assessing the incidence of morbidity and mortality have been based on a small number of CV events and/or a relatively short observation period. 8 -14 Information on the clinical significance of WCHT and MHT can also be obtained by investigating whether, compared with "true" normotension, these conditions are accompanied by a greater rate of development of a "sustained" hypertensive state, ie, HT both in and outside the clinical environment. We have addressed this issue in the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) population by identifying subjects with WCHT and MHT through in-office and out-of-office BP measurements and by detecting the development of sustained HT (SHT) over a 10-year time interval, ie, a long follow-up that allowed a large number of cases to occur. A peculiar aspect of the study was that out-of-office BP was measured both at home and over 24 hours, which allowed us to obtain 2 separate identifications of WCHT and MHT. MethodsThe methodology used in the PAMELA Study has been reported in detail elsewhere. 12,15 Briefly, 3200 individuals were randomly selected from the white residents of Monza (a town in the northeast outskirts of Milan), to be representative of its residents for sex, age (25 to 74 years), and socioeconomic characteristics, according to the criteria used by the World Health Organization Monitoring Diseases Project 16 conducted in the same geographic area. 6 Data were collected in 2051 subjects (64% of the original sample), and survivors were contacted 10 years later to be re-examined. All of the subjects agreed to participate in the study after explanation of its nature and purpose the study, and protocol was approved by the ethics committee of the institutions involved.Continuing medical education (CME) credit is available for this article. Go to http://cme.ahajournals.org to take the quiz.

show abstract

Section: Mancia Et Al Risk Of Developing Sustained Hypertensionmentioning

confidence: 88%

mentioning

confidence: 99%

Long-Term Risk of Sustained Hypertension in White-Coat or Masked Hypertension

Mancia¹,

Bombelli²,

Facchetti³

et al. 2009

Hypertension

265

178

View full text Add to dashboard Cite

show abstract

“…The prognostic significance of WCH is markedly controversial. Some studies [4][5][6][7][8][9][10] have showed WCH to be associated with a lower prevalence of metabolic risk factors and of targetorgan damage including left ventricular mass, media thickness of carotid arteries, forearm vascular resistance, and urinary albumin excretion such as that seen in sustained hypertension. In contrast, others have documented a greater prevalence of structural and functional organ damage [11][12][13][14][15][16][17] and more albuminuria [18] in WCH as compared with matched normotensive controls.…”

Section: Introductionmentioning

confidence: 99%

Sequential follow-up clinic and ambulatory blood pressure evaluation in a low risk population of white-coat hypertensive patients and in normotensives

Polónia¹,

Gama²,

Silva

et al. 2005

Blood Pressure Monitoring

View full text Add to dashboard Cite

show abstract

“…32,33 Few previous studies evaluated the relationships between aortic stiffness and isolated office hypertension, generally with small number of individuals and none in diabetic patients. The first one 16 suggested that patients with isolated office hypertension had higher aortic stiffness than those with sustained normal BP only if they had concomitantly other cardiovascular risk factors, such as diabetes or dyslipidemia. Another study 34 also reported greater aortic PWV in isolated office hypertensives than in sustained normotensives.…”

Section: Discussionmentioning

confidence: 99%

“…13 Type 2 diabetic patients have increased arterial stiffness 14,15 and are at particularly augmented risk for cardiovascular morbidity and mortality. Arterial hypertension and ageing are the main determinants of arterial stiffness; 13 and previous reports suggested that white-coat hypertensives may have higher arterial stiffness than normotensive individuals, 16 and that the white-coat effect may be associated with increased arterial stiffness. 17 Nevertheless, relationships between aortic stiffness and isolated office hypertension in diabetic patients have not been specifically investigated.…”

Section: Introductionmentioning

confidence: 97%

Uncontrolled isolated office hypertension is associated with subclinical markers of cardiovascular disease in hypertensive type 2 diabetic patients

et al. 2010

View full text Add to dashboard Cite

Isolated office hypertension (IOH) has been associated with structural cardiac abnormalities; however, its relation to worse cardiovascular prognosis remains uncertain. Less is known regarding the consequences of uncontrolled IOH in treated hypertensives. The aim was to investigate whether uncontrolled IOH was independently associated with two subclinical markers of cardiovascular disease, aortic stiffness and left ventricular hypertrophy (LVH). Clinical laboratory and 24-h ambulatory blood pressure (BP) data were obtained in 523 hypertensive patients with type 2 diabetes. Controlled office-ambulatory hypertension was defined by office blood pressure o140/90 mm Hg and 24-h BP o130/80 mm Hg, whereas uncontrolled IOH by office blood pressureX140/90 mm Hg and 24-h BP o130/80 mm Hg. Arterial stiffness was assessed by carotid-femoral pulse wave velocity (PWV) and left ventricular mass index (LVMI) by echocardiography. Statistics included multivariate linear and logistic regressions. According to BP patterns, 152 patients (29.1%) had controlled office-ambulatory hypertension, and 172 (32.9%) had uncontrolled IOH. Patients with uncontrolled IOH had greater LVMI (62.0 ± 21.9 vs. 52.9 ± 17.0 g m À2.7 , Po0.001) and PWV (11.5 ± 2.4 vs. 10.2 ± 2.1 m s À1 , Po0.001) than those with controlled hypertension. On linear model, after adjustment for several potential confounders, patients with uncontrolled IOH persisted with higher PWV (P¼0.003) and LVMI (P¼0.015). On logistic regression, the presence of uncontrolled IOH was independently associated with 2.7-fold (95% CI: 1.3-5.5) and 2.1-fold (95% CI: 1.1-4.0) higher risks of having increased aortic stiffness and LVH, respectively. In conclusion, uncontrolled IOH is associated with increased aortic stiffness and LVH in hypertensive type 2 diabetic patients. This may be a link to augmented cardiovascular risk. Keywords: aortic stiffness; left ventricular hypertrophy; type 2 diabetes; uncontrolled isolated office hypertension INTRODUCTION Some studies showed a better cardiovascular prognosis for isolated office hypertension patients (white-coat hypertension) than for those with sustained hypertension; 1-3 however, its prognostic significance in relation to sustained normal blood pressure (BP) remains controversial. 1,4-6 Nonetheless, isolated office hypertension has been associated with structural cardiac abnormalities in general population studies, mainly increased left ventricular mass, 7-9 which is a known marker of increased cardiovascular risk. 10 In normoalbuminuric type 2 diabetic patients, the prevalence of isolated office hypertension appears to be identical to hypertensive nondiabetic individuals, 11 and the presence of isolated office hypertension has been associated with macroalbuminuria and diabetic retinopathy. 12 However, less knowledge is available regarding the importance of uncontrolled isolated office hypertension (the white-coat effect) in treated hypertensives in relation to those with sustained controlled office and ambulatory hypertension.

show abstract

Arterial distensibility in subjects with white-coat hypertension with and without diabetes or dyslipidaemia: comparison with normotensives and sustained hypertensives

Cited by 23 publications

References 0 publications

Long-Term Risk of Sustained Hypertension in White-Coat or Masked Hypertension

Long-Term Risk of Sustained Hypertension in White-Coat or Masked Hypertension

Sequential follow-up clinic and ambulatory blood pressure evaluation in a low risk population of white-coat hypertensive patients and in normotensives

Uncontrolled isolated office hypertension is associated with subclinical markers of cardiovascular disease in hypertensive type 2 diabetic patients

Contact Info

Product

Resources

About