Cardiovascular Prognosis of "Masked Hypertension" Detected by Blood Pressure Self-measurement in Elderly Treated Hypertensive Patients

Bobrie, Guillaume; Châtellier, Gilles; Genès, N; Clerson, Pierre; Vaur, L; Vaı̈sse, B.; Ménard, J; Mallion, Jean-Michel

doi:10.1001/jama.291.11.1342

Cited by 751 publications

(481 citation statements)

References 28 publications

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“…17 The measurement of BP in a clinical setting tends to be a stressor itself, and can falsely increase BP and BP reactivity through what is recognized as the white coat effect. 18 Our observations provide additional support for the clinical usefulness of HBPM, 19 as compared with that of conventional clinical BP readings, [9][10][11] by demonstrating that HBPM data are likely to show good reproducibility, not only for sitting BP levels but also with respect to orthostatic BP changes.…”

Section: Discussionmentioning

confidence: 53%

“…3,[5][6][7][8] Home BP monitoring (HBPM) has been recently recommended as a convenient and reproducible method of BP measurement in hypertension management, with a better prognostic value than clinical BP measurements. [9][10][11] However, no data are available on the reproducibility of orthostatic BP changes when assessed by means of HBPM, which we previously showed to be more closely associated with increased albuminuria than when patients were assessed by clinical BP. 4 Hyperactivation of the sympathetic nervous system has been suggested as one of the mechanisms of OHT, in line with our previous finding that BP increase during head-up tilt in OHT subjects was blunted by alpha-adrenergic blockade.…”

Section: Introductionmentioning

confidence: 99%

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Orthostatic hypertension: home blood pressure monitoring for detection and assessment of treatment with doxazosin

et al. 2011

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To determine the role of home blood pressure (BP) monitoring for a reproducible assessment of orthostatic hypertension (OHT) and the effectiveness of hypertension control by doxazosin. In this study, 605 medicated hypertensive outpatients were enrolled. Home BP in the sitting and standing positions was monitored in all patients in the morning and evening for 6 months. According to an open-label multicenter trial design, the patients were randomly allocated to either an intervention group that took doxazosin (1-4 mg) at bedtime or to a control group that did not receive any add-on medication. The patients were divided into deciles of orthostatic BP change as evaluated by home BP monitoring at baseline. Those in the top decile, in the lowest decile and in deciles two through eight were then assigned to the OHT group, the orthostatic hypotension group and the orthostatic normotension group, respectively.Orthostatic BP in the OHYPO group did not change, whereas that of the OHT group was markedly reduced by doxazosin (Po0.01). In the control group, classification into orthostatic BP categories using home BP monitoring was more reproducible (j coefficient: 0.42-0.50) than when using clinical BP (j coefficient: 0.13-0.24). In all groups, a reduction in the urinary albumin/creatinine ratio was significantly associated with a reduction in orthostatic BP doxazosin (Po0.001).The identification of OHT based on home BP monitoring was highly reproducible. The administration of doxazosin might control OHT and consequently prevent target organ damage.

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Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Orthostatic hypertension: home blood pressure monitoring for detection and assessment of treatment with doxazosin

et al. 2011

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“…41 Both ABPM and SBPM can identify true hypertension, white coat hypertension and masked hypertension (normal office BP and elevated out of office BP). White coat and masked hypertension are common, each affecting 10-15% of the general population, with the latter associated with a doubling of cardiovascular risk.…”

Section: Discussionmentioning

confidence: 99%

Self blood pressure monitoring: a worthy substitute for ambulatory blood pressure?

McGowan

Padfield

2010

J Hum Hypertens

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lines for self-monitoring of blood pressure (SBPM). We aimed to demonstrate the equivalence of SBPM with ambulatory blood pressure monitoring (ABPM) in the assessment of hypertension. A total of 87 consecutive subjects referred from primary care for standard ABPM underwent a 1-week period of SBPM, as defined by the ESH guidelines, either before or after ABPM. There was no difference in mean blood pressure (BP): SBPM 142/ 87 mm Hg, daytime average ABPM 141/86 mm Hg. The intra-class correlation coefficient was 0.72 and 0.89 for systolic and diastolic pressure, respectively. SBPM is concordant with ABPM in classifying subjects as hypertensive or normotensive in 87% of cases (j ¼ 0.56). The coefficient of variation of SBPM compared with ABPM was 5%. In answer to a direct question 81% of subjects preferred SBPM to ABPM. The current self-monitoring schedule recommended by the ESH, AHA and ASH is valid. The mean BP obtained from SBPM is equivalent to awake-time BP on ABPM, the accepted reference standard for 'out of office' BP measurement. SBPM is simpler to carry out, preferred by patients and should be considered on a par with ABPM.

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“…25 Furthermore, prospective studies have revealed that a high ambulatory or home BP is a powerful predictor for cardiovascular morbidity and mortality in the general population and treated hypertensive patients even when their office BP is normal or well controlled. 10,11,[26][27][28] As for the association between LV geometry and cardiovascular prognosis, it was reported that hypertensive patients with concentric hypertrophy among four LV geometric patterns had the highest incidence of cardiovascular events and death. 13 Taken together, it is likely that advanced target organ changes including LV concentric hypertrophy in patients with masked hypertension or reverse whitecoat condition are linked to poor cardiovascular prognosis in such patients.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies suggested that an elevated ambulatory or home BP despite a well-controlled office BP is associated with poor cardiovascular prognosis in treated hypertensive patients. 10,11 However, it remains unclear what mechanism is involved in the association of reverse white-coat phenomenon with cardiovascular prognosis.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2006

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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.

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Cardiovascular Prognosis of "Masked Hypertension" Detected by Blood Pressure Self-measurement in Elderly Treated Hypertensive Patients

Cited by 751 publications

References 28 publications

Orthostatic hypertension: home blood pressure monitoring for detection and assessment of treatment with doxazosin

Orthostatic hypertension: home blood pressure monitoring for detection and assessment of treatment with doxazosin

Self blood pressure monitoring: a worthy substitute for ambulatory blood pressure?

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

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