Cardiac and Arterial Target Organ Damage in Adults with Elevated Ambulatory and Normal Office Blood Pressure

Liu, Jennifer E.; Roman, Mary J.; Pini, Riccardo; Schwartz, Joseph E.; Pickering, Thomas G.; Devereux, Richard B.

doi:10.7326/0003-4819-131-8-199910190-00003

Cited by 305 publications

(145 citation statements)

References 38 publications

Supporting

Mentioning

129

Contrasting

Unclassified

Order By: Relevance

“…Regardless of whether outof-office BP is measured by HBP or ABP, the risk of experiencing a cardiovascular event is similar to that observed in patients with sustained hypertension (Figure 1). These findings strengthen the observations from numerous earlier crosssectional studies that linked MH with target organ damage (14,15). Taken together, it is clear that both HBP and ABP predict cardiovascular risk better than OBP.…”

Section: What Is the Risk Associated With Mh?supporting

confidence: 79%

See 1 more Smart Citation

Masked hypertension: A common but insidious presentation of hypertension

McKay

Myers

Bolli³

et al. 2006

Canadian Journal of Cardiology

View full text Add to dashboard Cite

M asked hypertension (MH) is strongly linked to an increased risk of heart disease and stroke (1-4). Mounting evidence suggests that MH must be taken into account in the assessment of blood pressure (BP), but little is known about how masked hypertensive patients are identified or how they should be managed. Despite prevalence estimates of at least 8% to 10% in the general population and a prognosis similar to sustained hypertension, the term, the meaning and the importance of MH are not widely understood. The present article provides some background on MH, describes its clinical importance and discusses some aspects of management in clinical practice. What is MH?MH is present when a normal office BP (OBP) is recorded in a patient with ambulatory BP (ABP) or home BP (HBP) readings in the hypertensive range (5). As the term implies, the hypertension is real but is masked to the physician. Patients with this condition have a normal or, more commonly, high normal OBP of less than 140/90 mmHg. Although ABP and HBP testing is not performed routinely in patients whose BP is less than 140/90 mmHg, various research studies have examined the relationship between normal OBP and ABP or HBP in a variety of populations. Over the past three years, four large, prospective studies (1-4) have reported that patients with MH exhibit a risk profile similar to those who have sustained hypertension.However, many health care professionals are unfamiliar with the concept of MH. This is possibly because of inconsistent nomenclature in the scientific or medical literature. However, the phenomenon of MH is not new. The classic paper on ABP monitoring was written by Perloff et al in 1983 (6), and demonstrated not only the superiority of ABP over OBP in predicting clinical outcomes, but also showed poorer outcomes in patients who had higher ABP values compared with their borderline or mildly hypertensive OBP. Since then, others who have observed this same phenomenon have called it a variety of names, including white coat normotension (7), reverse white coat (8), inverse white coat (9), home or isolated home hypertension (7,10), isolated ambulatory hypertension (11), isolated uncontrolled hypertension at home (12) and occult office hypertension (13). Pickering et al (5) suggested the term 'masked hypertension', and this term appears to have become the standard terminology to describe patients who have a normal OBP but elevated HBP or ABP. A patient has masked hypertension when his office blood pressure is less than 140/90 mmHg but his ambulatory or home blood pressure readings are in the hypertensive range. Several recent studies have demonstrated that cardiovascular risk is similar between those with masked hypertension and those with sustained hypertension. The prevalence of masked hypertension in Canada is not known, but data from other countries suggest rates greater than 8%. Physicians need to use careful clinical judgment to identify and treat subjects with masked hypertension. The present review discusses masked hypertension, its imp...

show abstract

Section: What Is the Risk Associated With Mh?supporting

confidence: 79%

“…When the level of the OBP has been taken into consideration, studies reporting a link between MH and target organ damage show that OBP is commonly in the high normal range when MH is present (14,20). This finding may have clinical significance.…”

Section: What Is the Risk Associated With Mh?mentioning

confidence: 91%

Masked hypertension: A common but insidious presentation of hypertension

McKay

Myers

Bolli³

et al. 2006

Canadian Journal of Cardiology

View full text Add to dashboard Cite

show abstract

“…Cross-sectional studies have reported an increased incidence of precursors of cardiovascular disease such as left ventricular hypertrophy. [12][13][14][15][16][17] However, prospective studies appear to offer the best opportunity in which to detect an effect and reported studies are divided into those who find that the white-coat effect has adverse consequences for cardiovascular disease [18][19][20] and those that find that it does not. 6,[21][22][23][24][25][26] We have previously reported 11-year mortality data in the General Practice Hypertension Study Group (GPHSG) in subjects with transiently raised clinic DBP, and found the relative risk of cardiovascular death compared with controls was 1.5 in men and 0.7 in women compared to normotensive controls 27 but these results were not statistically significant.…”

Section: Introductionmentioning

confidence: 99%

Transiently elevated diastolic blood pressure is associated with a gender-dependent effect on cardiovascular risk

Wingfield¹,

Grodzicki

Palmer

et al. 2005

J Hum Hypertens

View full text Add to dashboard Cite

We assessed the morbidity and mortality of subjects with transiently elevated diastolic pressure in the General Practice Hypertension Study Group (GPHSG) population. A total of 23 578 patients (aged 18-65 years) from seven UK general practices were screened in 1974 for a diastolic blood pressure (DBP4) of X90 mmHg. Two further readings of DBP4 determined hypertensive (either DBP4X90 mmHg) or transient hypertensive (both DBP4o90 mmHg) status. Transients (n ¼ 850) were matched with normotensive controls (n ¼ 824) and risk ratios calculated over a mean follow-up of 18.7 years. Rescreening was conducted in six of the practices (n ¼ 20 942) after 7.7 years. Male transients had a higher relative hazard for cardiovascular mortality than controls (11.8%, 8.6%, adjusted relative hazard 1.59, P ¼ 0.056). Female transients had a lower relative hazard for cardiovascular mortality than controls (3.6%, 5.4%, adjusted relative hazard 0.39, P ¼ 0.018). In all, 422 patients with transient hypertension were rescreened along with 367 matched controls. Significantly more transients were on antihypertensive treatment compared with their controls (odds ratio (OR) [95% CI]) for both male (4.2 [1.6-11.1]) and female patients (2.4 [1.0-5.56]) and more untreated female transients developed hypertension. Male transients had a higher rates of diabetes mellitus (adj OR ¼ 5.1, P ¼ 0.04) and stroke (adj OR 15.9, P ¼ 0.03). This study has shown that transiently elevated DBP in GPHSG is associated with a significantly higher risk of later hypertension in men and women and of diabetes, stroke and cardiovascular mortality in men. Women with this condition have a significantly lower cardiovascular mortality.

show abstract

“…There have been a few studies reporting the possible association between masked hypertension and cardiac and carotid arterial structural changes in the general population. Liu et al 23 found that LV mass and carotid wall thickness in patients with masked hypertension were significantly greater than those in true normotensive subjects and similar to those in patients with sustained hypertension. The data from the PAMELA Study also showed that LVMI was Figure 3 Comparison of LV geometric patterns between the two groups.…”

Section: Discussionmentioning

confidence: 90%

Reverse white-coat effect as an independent risk for left ventricular concentric hypertrophy in patients with treated essential hypertension

et al. 2006

View full text Add to dashboard Cite

Recent studies have shown that the converse phenomenon of white-coat hypertension called 'reverse white-coat hypertension' or 'masked hypertension' is associated with poor cardiovascular prognosis. We assessed the hypothesis that this phenomenon may specifically influence left ventricular (LV) structure in treated hypertensive patients. A total of 272 outpatients (mean age, 65 years) with chronically treated essential hypertension and without remarkable white-coat effect were enrolled. Patients were classified into two groups according to office and daytime ambulatory systolic blood pressure (SBP); that is subjects without (Group 1: office SBP Xdaytime SBP, n ¼ 149) and with reverse white-coat effect (Group 2: office SBPodaytime SBP, n ¼ 123). LV mass index and relative wall thickness were echocardiographically determined. In all subjects, LV mass index and relative wall thickness were positively correlated with daytime and 24-h SBP, but not with office SBP. In addition, these two indices were inversely correlated with office -daytime SBP difference. LV mass index (136731 and 115728 g/m 2 , mean7s.d.) and relative wall thickness (0.4970.09 and 0.4670.07) were significantly greater in Group 2 than in Group 1. As for LV geometric patterns, Group 2 had a significantly higher rate of concentric hypertrophy compared with Group 1 (48 and 28%). Multivariate analyses revealed that the presence of reverse white-coat effect was a predictor for LV concentric hypertrophy, independent of age, sex, hypertension duration, antihypertensive treatment and ambulatory blood pressure levels. Our findings demonstrate that reverse white-coat effect is an independent risk factor for LV hypertrophy, especially concentric hypertrophy, in treated hypertensive patients.

show abstract

Cardiac and Arterial Target Organ Damage in Adults with Elevated Ambulatory and Normal Office Blood Pressure

Cited by 305 publications

References 38 publications

Masked hypertension: A common but insidious presentation of hypertension

Masked hypertension: A common but insidious presentation of hypertension

Transiently elevated diastolic blood pressure is associated with a gender-dependent effect on cardiovascular risk

Reverse white-coat effect as an independent risk for left ventricular concentric hypertrophy in patients with treated essential hypertension

Contact Info

Product

Resources

About