Prognosis of White-Coat and Masked Hypertension

Abstract

Home blood pressure monitoring is useful in detecting white-coat and masked hypertension and is recommended for patients with suspected or treated hypertension. The prognostic significance of white-coat and masked hypertension detected by home measurement was investigated in 6458 participants from 5 populations enrolled in the International Database of HOme blood pressure in relation to Cardiovascular Outcomes. During a median follow-up of 8.3 years, 714 fatal plus nonfatal cardiovascular events occurred. Among untreated subjects (n=5007), cardiovascular risk was higher in those with white-coat hypertension (adjusted hazard ratio 1.42; 95% CI [1.06–1.91]; P =0.02), masked hypertension (1.55; 95% CI [1.12–2.14]; P <0.01) and sustained hypertension (2.13; 95% CI [1.66–2.73]; P <0.0001) compared with normotensive subjects. Among treated patients (n=1451), the cardiovascular risk did not differ between those with high office and low home blood pressure (white-coat) and treated controlled subjects (low office and home blood pressure; 1.16; 95% CI [0.79–1.72]; P =0.45). However, treated subjects with masked hypertension (low office and high home blood pressure; 1.76; 95% CI [1.23–2.53]; P =0.002) and uncontrolled hypertension (high office and home blood pressure; 1.40; 95% CI [1.02–1.94]; P =0.04) had higher cardiovascular risk than treated controlled patients. In conclusion, white-coat hypertension assessed by home measurements is a cardiovascular risk factor in untreated but not in treated subjects probably because the latter receive effective treatment on the basis of their elevated office blood pressure. In contrast, masked uncontrolled hypertension is associated with increased cardiovascular risk in both untreated and treated patients, who are probably undertreated because of their low office blood pressure.

Blood Pressure Phenotypes in Treated Hypertensive Patients in Summer and Winter: Focus on Masked Uncontrolled Hypertension. Part 1: Blood Pressure Phenotypes Prevalence

“…This term is seemed to be eligible (especially in cases of WCH and masked hypertension) as each of the types has peculiar characteristics including social-demographic and clinical patients' features [3][4][5][6]. Besides, a number of studies had proved prognostic value of unfavorable BP phenotypes in respect of fatal and non-fatal cardiovascular events [3,7]. One can suppose that further studies will allow to determine some genetic markers of BP phenotypes, in the first place of those linked to psychological and behavioral features of patients.…”

“…Использование данного термина (особенно в от-ношении ГБХ и скрытой АГ) представляется правомочным, поскольку существует комплекс основных характеристик каждого из них, включающий социально-демографиче-ские и клинические особенности пациентов [3][4][5][6]. Кроме того, в ряде исследований доказана прогностическая значи-мость неблагоприятных фенотипов АД в отношении фа-тальных и нефатальных сердечно-сосудистых событий [3,7]. Можно предполагать, что дальнейшие исследования позволят определить и некоторые генетические маркеры фенотипов АД, в первую очередь, взаимосвязанные с психологическими и поведенческими особенностями пациентов.…”

“…At that risk of cardiovascular events including fatal ones in masked uncontrolled hypertension is as high as in overt uncontrolled hypertension [3,4,7]. It is not by chance that diagnostics of BP phenotypes connected with the "white coat" phenomenon and with the masked hypertension phenomenon is now considered the main indication for the BP 24-hour monitoring [3,4].…”

“…В тоже время риск сердечно-сосудистых событий, в том числе фатальных, при скрытой неэффек-тивности лечения АГ так же высок, как и при «явно» не-эффективной АГТ [3,4,7]. Не случайно диагностика фено-типов АД, связанных как с феноменом «белого халата» ("white coat" phenomenon), так и со скрытой АГ (masked phenomena), признана в настоящее время основным показа-нием к суточному мониторированию АД (СМАД) [3,4].…”

Masked Hypertension: An Independent Cardiovascular Risk Factor or a Facet of True Blood Pressure Level?

“…According to several studies, the lifestyle and metabolic risk profile of patients with MHT resembles that of sustained hypertensive participants 5, 6, 7, 8. Most important, patients with MHT, diagnosed by home or ambulatory BP monitoring, have an increased risk of cardiovascular morbidity and mortality compared with persons with sustained normotension 8, 9, 10. Even patients with white coat hypertension have an increased risk of sustained hypertension and cardiovascular events 9, 10, 11…”