Masked hypertensives: A disguised arterial stiffness population

Abstract

The aim of this study was to determine whether masked hypertension (MHT) and white coat hypertension (WCHT) could be related to increased arterial stiffness and to identify the best office cutoff values of office BP for the diagnosis of MHT and WCHT. A total of 542 consecutive patients (50.2% male, age 42.5 ± 26.2 years) were included in the study. Patients were never treated before for hypertension. Patients were classified as true normotensives (44%), true hypertensives (30%), WC hypertensives (19%), and masked hypertensives (7%). Carotid‐femoral pulse wave velocity (c‐f PWV) was 9.91 ± 0.20 m/s in true normotension, 10.26 ± 0.27 m/s in WCHT, 11.28 ± 0.47 m/s in MHT, and 11.86 ± 0.23 m/s in true hypertension after adjustment for age and sex. Decision limits yielding 65% sensitivity were 130 mm Hg for office systolic BP with 72% specificity for the diagnosis of MHT. The optimal cutoff value of 80 mm Hg for office diastolic BP provides 60% sensitivity and 68% specificity. Decision limits yielding 63% sensitivity were 150 mm Hg for office systolic BP with 72% specificity for the diagnosis of WCHT. The optimal cutoff value of 95 mm Hg for office diastolic BP provides 75% sensitivity and 51% specificity. The presence of MHT should be taken into account when increased c‐f PWV is detected in the absence of office hypertension. The optimal office BP of 130/80 mm Hg provides the best sensitivity and specificity for the diagnosis of MHT. As regards the diagnosis of WCHT, the cutoff value of 150/95 mm Hg seems to provide the best option.

Hypertension and arterial stiffness

“…Blood pressure monitoring has been established in clinical and research settings as a reliable technique to assess BP, heart rate, and their circadian variations, and it has been shown to correlate with target organ damage and mortality better than office BP measurements …”

“…Far from being clinically innocent conditions, WCHT and MHT have been related to asymptomatic cardiac and vascular damage as well as an overall raised long‐term risk of cardiovascular events, after adjustment for demographic and metabolic risk factors . Interestingly, patients with WCHT and MHT have higher BPV than normotensive people, and this may, at least partially, explain the relationship linking these hypertension phenotypes to adverse cardiovascular outcome. Indeed, there is accruing evidence that BPV does not merely represent a random effect phenomenon or a background noise that dilutes the prognostic value of BP assessment, but it is reproducible within individuals over time .…”

“…Blood pressure monitoring has been established in clinical and research settings as a reliable technique to assess BP, heart rate, and their circadian variations, and it has been shown to correlate with target organ damage and mortality better than office BP measurements. 1,2 Blood pressure monitoring can result into the detection of two distinct hypertension phenotypes, namely WCHT and MHT. WCHT refers to the untreated condition in which BP is high in the office, whereas it is normal when measured by ambulatory and/or home BP monitoring.…”

“…In this issue of The Journal of Clinical Hypertension , Dr Antza and colleagues explored whether white coat hypertension (WCHT) and masked hypertension (MHT) were related to increased arterial stiffness in an untreated population . In a cohort of 542 consecutive subjects never been on antihypertensive medications, a significant association between MHT and raised carotid‐femoral pulse wave velocity (c‐f PWV) emerged . Additionally, patients presenting with WCHT showed higher values of systolic blood pressure variability (BPV) in comparison with true normotensive .…”

“…1 Additionally, patients presenting with WCHT showed higher values of systolic blood pressure variability (BPV) in comparison with true normotensive. 1 MHT resembled to true hypertension according to day and night systolic variability in BP. 1 These findings expand the current body of knowledge about blood pressure (BP) phenotypes and provide useful insights upon the pathophysiological mechanisms linking hypertension to target organ damage.…”