Consequence of Masked Hypertension in Treated Hypertensive Outpatients: 1-Year Follow-Up Study

Abstract

Since masked hypertension (MHT) is high risk for cardiovascular disease, the importance of home blood pressure (HBP) control is emphasized. The aim of this study was to investigate the prevalence of MHT in the treated hypertensives and the consequence of their BP control status after a 1-year follow up period. Subjects are 262 treated hypertensive outpatients. We assessed BP control status, background characteristics, and antihypertensive drugs in both 2008 and 2009. Clinic BP (CBP) and morning HBP in 2008 were 133 ± 12/73 ± 9 mmHg and 132 ± 11/77 ± 8 mmHg, which significantly decreased to 129 ± 11/70 ± 10 mmHg and 130 ± 10/76 ± 8 mmHg in 2009, respectively (p < 0.01). The patients with sustained hypertension (SHT) decreased from 17.9% in 2008 to 6.9% in 2009. Thirty-four percent of SHT patients in 2008 turned out to be MHT and another 34.0% belonged to normotension (NT) in 2009. Among 79 MHT patients in 2008, 62.0% remained as MHT, while 32.9% turned out to be NT in 2009. The sustained MHT patients were more male and showed a higher prevalence of habitual alcohol intake. Nighttime dosing of antihypertensive drugs and the addition of diuretics were major causes of improving morning HBP. Results suggest that one-third of MHT patients showed the improvement of HBP after the 1-year follow-up period. Not only intensive antihypertensive treatment with the appropriate use of diuretics, but also the encouragement of lifestyle modification including alcohol restriction, seems to be important to the management of MHT.

Differences of blood pressure measured at clinic versus at home in the morning and in the evening in Europe and Asia: A systematic review and meta‐analysis

“…Among the included studies, 22 studies contained both home morning and evening BP values, 6 , 7 , 8 , 9 , 10 , 11 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 whereas 13 studies contained only home morning BP values. 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 10 studies were conducted in European countries. 6 , 7 , 8 , 15 , 16 , 17 , 18 , 19 , 22 , 25 whereas 25 studies were conducted in Asian countries 9 , 10 , 11 , 20 , 21 , 23 , …”

“… 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 10 studies were conducted in European countries. 6 , 7 , 8 , 15 , 16 , 17 , 18 , 19 , 22 , 25 whereas 25 studies were conducted in Asian countries 9 , 10 , 11 , 20 , 21 , 23 , 24 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 (22 in Japan). 9 , 10 , 11 , 20 , 21 ,…”

Relationship between Blood Pressure Control Status and Lifestyle in Hypertensive Outpatients

“…We have previously reported that patients with metabolic syndrome show higher urinary salt excretion and need more antihypertensive drugs to manage their BP (17). Habitual drinking, male gender and older age are also reported to associate with persistently uncontrolled home BP (2,18). Since marked BP reduction can be achieved by a combination of salt restriction, weight loss, exercise, restriction of alcohol intake, and a DASH diet (19), comprehensive lifestyle modifications seem to be important for achieving BP control in hypertensive patients, in particular, young male patients with obesity.…”

“…Blood pressure (BP) control was reported to be inadequate on the basis of either the routine clinic BP or home BP measurement (1)(2)(3). The Japanese Society of Hypertension guideline (JSH 2009) emphasizes that the use of two or three drugs including a low dose of diuretic is necessary to achieve the target BP (4).…”

Frequency of masked hypertension and its relation to target organ damage in the heart

“…These include male gender, alcohol consumption, obesity, smoking, physical activity, and psychosocial factors such as anxiety, interpersonal conflicts and job stress. 18 There was no significant difference in age between patients with MH and patients with SH or WCH, however, age was significantly higher in MH than true normotensive patients. There was no significant difference in sex incidence between patients with MH and patients with SH or true normotensive patients, however, male sex was significantly higher in MH than WCH.…”