Clinical features and predictors of masked uncontrolled hypertension from the Korean Ambulatory Blood Pressure Monitoring Registry

Abstract

Background/Aims: The clinical characteristics of patients with masked uncontrolled hypertension (MUCH) have been poorly defined, and few studies have investigated the clinical predictors of MUCH. We investigated the demographic, clinical, and blood pressure (BP) characteristics of patients with MUCH and proposed a prediction model for MUCH in patients with hypertension. Methods: We analyzed 1,986 subjects who were enrolled in the Korean Ambulatory Blood Pressure Monitoring (Kor-ABP) Registry and taking antihypertensive drugs, and classified them into the controlled hypertension (n = 465) and MUCH (n = 389) groups. MUCH was defined as the presence of a 24-hour ambulatory mean systolic BP ≥ 130 mmHg and/or diastolic BP ≥ 80 mmHg in patients treated with antihypertensive drugs, having normal office BP. Results: Patients in the MUCH group had significantly worse metabolic profiles and higher office BP, and took significantly fewer antihypertensive drugs compared to those in the controlled hypertension group. Multivariate logistic regression analyses identified high office systolic BP and diastolic BP, prior stroke, dyslipidemia, left ventricular hypertrophy (LVH, ≥ 116 g/m 2 for men, and ≥ 96 g/m 2 for women), high heart rate (≥ 75 beats/min), and single antihypertensive drug use as independent predictors of MUCH. A prediction model using these predictors showed a high diagnostic accuracy (C-index of 0.839) and goodness-of-fit for the presence of MUCH. Conclusions: MUCH is associated with a high-normal increase in office BP and underuse of antihypertensive drugs, as well as dyslipidemia, prior stroke, and LVH, which could underscore achieving optimal BP control. The proposed model accurately predicts MUCH in patients with controlled office BP.

Prediction of Masked Uncontrolled Hypertension Detected by Ambulatory Blood Pressure Monitoring

“…When we applied to our population the prediction model suggested by Kim et al [ 34 ], the AUC for MUCH defined by 24 h BP threshold was 0.73, 95% CI 0.69–0.77. If we used in our population the best prediction model suggested by Hung et al [ 35 ], although they used a different definition of MUCH and also included patients with masked hypertension, the AUC for MUCH defined by 24 h BP threshold (our definition that most closely matched their definition of MUCH) was 0.72, 95% CI 0.68–0.75.…”

“…The present study shows that: (1) male sex, smoking habit, LV hypertrophy, a clinic systolic BP in the range of 130–139 mmHg, and/or a clinic diastolic BP in the range of 85–89 mmHg are associated with MUCH defined by both daytime and 24 h BP thresholds; (2) prediction models based on the abovementioned variables were appropriate in identifying the presence of MUCH; (3) internal validation indicated a good predictive performance of the models. Though characteristics of patients with MUCH have been described in previous studies [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 31 , 32 , 33 ], few reports [ 34 , 35 ] have attempted to provide prediction models. Kim et al [ 34 ], studied 854 treated hypertensive patients with normal clinic BPs (<140/90 mmHg) enrolled in the Korean Ambulatory BP Monitoring Registry.…”

“…Though characteristics of patients with MUCH have been described in previous studies [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 31 , 32 , 33 ], few reports [ 34 , 35 ] have attempted to provide prediction models. Kim et al [ 34 ], studied 854 treated hypertensive patients with normal clinic BPs (<140/90 mmHg) enrolled in the Korean Ambulatory BP Monitoring Registry. Among them, 465 had CH and 389 had MUCH defined as 24 h BP < or ≥130 and/or 80 mmHg, respectively.…”

“…In this context, it would be useful to find prediction models that could help to select patients eligible for out-of-office BP evaluation. Though factors associated with MUCH have been described in previous studies [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 31 , 32 , 33 ], few reports [ 34 , 35 ] have attempted to provide prediction models. Thus, other studies could be helpful to add further knowledge on this matter.…”

Nomogram based on clinical features at a single outpatient visit to predict masked hypertension and masked uncontrolled hypertension: A study of diagnostic accuracy

“…Because this study had partially missing data, imputation of missing values took the method of multiple imputations five times, and the numerical value of these imputations was taken as the final data of the study while missing categorical variables took the method of deletion and were excluded from this study. [25] Statistical analysis was performed by R 4.1.3 and SPSS 27.0 in this study. Quantitative variables are expressed as mean ± SD (x ± s), and categorical variables are expressed as percentages (%).…”