Central blood pressure augmentation and central-to-peripheral blood pressure amplification in relation to cardiovascular end points

Abstract

s e5with white-coat hypertension (WCH) it is virtually the same as in the normotensive individuals. However, no conclusive evidence exists as to whether WCH and MH are accompanied by a greater rate of development of a "sustained" hypertensive state, i.e. hypertension both in and outside the clinical environment. We investigated the risk of progression to sustained hypertension in initially untreated participants of cohort studies included in the International Database on Ambulatory blood pressure in relation to Cardiovascular Outcome (IDACO) study.Within the IDACO, 5 populations comprising 1081 individuals had ambulatory (ABP) and conventional (CBP) blood pressure measured at baseline and at follow up. We excluded from the analysis subjects on BP-lowering treatment at baseline (n=252) and individuals with untreated sustained hypertension at baseline (n=80), leaving 749 subjects included in the current analysis. The cut-off value for elevated CBP was ≥140/90 mm Hg and for daytime ABP ≥135/85 mm Hg.At baseline, 110 individuals (14.7%) was defined as MH, 64 subjects as WCH (8.5%), and 575 (76.8%) as normotensives. MH patients were older (50 vs 45 years compared to normotensives, P<0.01) and more frequently male (50.9 vs 31.5% compared to normotensives, P<0.01). During median follow-up of 9.7 years, there were 264 incident cases of sustained hypertension. In the analyses adjusted for cohort, sex, age, body mass index, smoking and drinking, both MH (hazard ratio, 2.23; 95% confidence interval, 1.57-3.17) and WCH (hazard ratio, 1.84; 95% confidence interval, 1.37-2.47) significantly increased risk of progression to sustained hypertension.