Isolated ambulatory hypertension is common in outpatients referred to a hypertension centre

Ungar, Andrea; Pepe, Guglielmina; Monami, Matteo; Lambertucci, L.; Torrini, M.; Baldasseroni, Samuele; Tarantini, Francesca; Marchionni, Niccolò; Masotti, Giulio

doi:10.1038/sj.jhh.1001756

Cited by 32 publications

(29 citation statements)

References 29 publications

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“…18 Furthermore, in a study of 1,488 hypertensive subjects, comprising MH of 10% prevalence, 2 variables (SBP <125 mmHg (RR 0.84, 95%CI 0.75-0.94) and DBP <76 mmHg (RR 0.85, 95%CI 0.76-0.96)) were found to have a negative predictive value. 19 Our result that high OBP, especially if >125/80 mmHg, has predictive value for MH suggests that such patients should have their HBP measured or undergo ABPM, even among clinically well-controlled hypertensive patients.…”

Section: Discussionmentioning

confidence: 99%

Detection of Masked Hypertension and the Mask Effect' in Patients With Well-Controlled Office Blood Pressure

Park

Choi

et al. 2011

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp he assessment of out-of-office blood pressure (BP), using either ambulatory or home BP monitoring, has enabled detection of masked hypertension (MH) and the "white-coat" hypertension (WCH) phenomena. Studies have shown that MH carries a similar cardiovascular risk to uncontrolled hypertension (UH). 1 Both home BP self-measurement (HBP) and ambulatory BP monitoring (ABPM) have been shown to be better correlated with target organ damage than conventional BP measurement in a clinic office. 2 Moreover, several studies have shown that either self-measured HBP or ABPM can predict cardiovascular mortality and morbidity more accurately than BP measurements at a clinic. 3-5 Even in a patient whose conventionally measured office BP (OBP) is normal, the self-measured HBP or ABPM value may still be high. In other words, UH can remain hidden until self-measurement of HBP or ABPM is performed.The "white-coat" effect (WCE), which is usually defined as the difference between the OBP and HBP (or ABPM), is typically positive and present in the majority of hypertensive patients. 6 The term 'negative WCE' is used when the OBP minus HBP is a negative value. The magnitude of the nega- Background: Masked hypertension (MH) is characterized by its hidden nature and poor prognosis. However, it is not practical to routinely recommend home or ambulatory blood pressure monitoring (HBP or AMBP) to all patients with apparently well-controlled BP. The purpose of this study is to present, within the group of patients with well-controlled office BP (OBP), the clinical predictors of MH and to evaluate the gap (ie, the 'mask effect' (ME)) between OBP and HBP.

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Section: Discussionmentioning

confidence: 99%

Detection of Masked Hypertension and the Mask Effect' in Patients With Well-Controlled Office Blood Pressure

Park

Choi

et al. 2011

Circ J

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“…[7][8][9] Nonetheless, there are large differences in the prevalence of this condition, and these studies are not strictly comparable from a methodologic point of view. Interestingly, we observed a lower prevalence of isolated office control than the prevalence of masked hypertension reported in other studies.…”

Section: The Burden Of Undetected Controlled and Uncontrolled Hypertementioning

confidence: 96%

“…Interestingly, we observed a lower prevalence of isolated office control than the prevalence of masked hypertension reported in other studies. 8,9,14 Although the selection of patients in our study may partially explain these differences, interstudy comparisons are inevitably difficult. Methodologic differences aside, in our study, as in the Pressioni Arteriose Monitorate e Loro Associazioni study in Italy, office resistance was much more common than isolated office control.…”

Section: The Burden Of Undetected Controlled and Uncontrolled Hypertementioning

confidence: 97%

Effectiveness of Blood Pressure Control Outside the Medical Setting

Banegas¹,

Segura²,

Sobrino³

et al. 2007

Hypertension

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Abstract-We studied the effectiveness of blood pressure (BP) control outside the clinic by using ambulatory BP monitoring (ABPM) among a large number of hypertensive subjects treated in primary care centers across Spain. The sample consisted of 12 897 treated hypertensive subjects who had indications for ABPM. Office-based BP was calculated as the average of 2 readings. Twenty-four-hour ABPM was then performed using a SpaceLabs 90207 monitor under standardized conditions. A total of 3047 patients (23.6%) had their office BP controlled, and 6657 (51.6%) were controlled according to daytime ABPM. The proportion of office resistance or underestimation of patients' BP control by physicians in the office (office BP Ն140/90 mm Hg and average daytime ambulatory BP Ͻ135/85 mm Hg) was 33.4%, and the proportion of isolated office control or overestimation of control (office BP Ͻ140/90 mm Hg and average daytime ambulatory BP Ն135/85 mm Hg) was 5.4%. BP control was more frequently underestimated in patients who were older, female, obese, or with morning BP determination than in their counterparts. BP control was more frequently overestimated in those who were younger, male, nonobese, smokers, or with evening BP determination. Ambulatory-based hypertension control was far better than office-based hypertension control. This conveys an encouraging message to clinicians, namely that they are actually doing better than is evidenced by office-based data. However, the burden of underestimation and overestimation of BP control at the office is still remarkable. Physicians should be aware that the likelihood of misestimating BP control is higher in some hypertensive subjects. Key Words: office blood pressure Ⅲ ambulatory blood pressure Ⅲ treatment goals Ⅲ guidelines Ⅲ control A dequate control of hypertension is low in population and medical settings. 1-3 However, physicians frequently misclassify patients' blood pressure (BP) status at the office when compared with ambulatory BP monitoring (ABPM). 4 In particular, BP readings are higher in standard clinical practice than in ambulatory readings. 4,5 Nevertheless, the magnitude of the gap between office and ambulatory BP control has not been noted in large-scale studies addressing daily practice.Furthermore, the prevalence and determinants of BP conditions, such as white-coat hypertension ([WCH] ie, high office BP with normal BP outside the medical setting) and masked hypertension (normal office BP with high BP outside the medical setting) have already been studied. 6 -14 However, WCH is a term reserved for those subjects not on antihypertensive treatment 6 ; and in the case of treated hypertensive subjects, it would, therefore, be more accurate to use the term "office resistance," 6 that is, in-clinic BP readings that are both higher than goal despite treatment and higher than normotensive BP outside the clinic as demonstrated by ABPM. Likewise, we focused on "isolated office control" (BP controlled at the office but uncontrolled on ABPM despite treatment) rather than masked hyper...

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“…Em diversos estudos, a prevalência de HM variou de 8% a 48%. [54][55][56] Esta condição deve ser pesquisada em indivíduos com PA normal ou limítrofe e mesmo nos hipertensos con trolados, mas com sinais de lesões em órgãos-alvo, histórico familiar positivo para HAS, risco cardiovascular alto, e medi da casual fora do consultório anormal 26,27 (D). Os pacientes portadores de HM devem ser identificados e acompanhados, pois apresentam risco de desenvolver lesões de órgãos-alvo de forma semelhante a pacientes hipertensos 57 (A).…”

Section: Hipertensão Do Avental Brancounclassified