Sequential follow-up clinic and ambulatory blood pressure evaluation in a low risk population of white-coat hypertensive patients and in normotensives

Polónia, Jorge; Gama, Guilherme; Silva, José A.; Amaral, Cristina; Martins, Luís; Bertoquini, Susana

doi:10.1097/00126097-200504000-00001

Cited by 30 publications

(25 citation statements)

References 36 publications

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“…Prognostic significance of WCH remains controversial and there are various reports about it. 1,2) But most of the already per-formed studies of WCH have just focused on the progression to HT in time 3,4) or whether or not it already causes target organ damage. 5) As a different topic, we tried to understand whether or not WCH is already associated with smoking, overweight, obesity, IGT or type II DM, and dyslipidemia like disorders as in HT.…”

Section: Introductionmentioning

confidence: 99%

White Coat Hypertension Is Associated with a Greater All-cause Mortality

Helvacı

Kaya

Seyhanli

et al. 2007

JOURNAL OF HEALTH SCIENCE

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Background: Prognostic significance of white coat hypertension (WCH) remains controversial and most of the studies have just focused on the progression to hypertension (HT) or whether or not it already causes target organ damage. Methods: We studied consecutive adults and eldelies with sustained normotension (NT), WCH, and HT applying to the Internal Medicine Polyclinic. A 10 day twice daily measurement of blood pressure at home (HBP) was obtained in all cases, and a 24 hr ambulatory blood pressure monitoring (ABPM) was performed just for the cases with higher office and/or HBP measurements. Prevalences of smoking, overweight, obesity, impaired glucose tolerance, type II diabetes mellitus, hyperbetalipoproteinemia, hypertriglyceridemia, and dyslipidemia were calculated in each group and results were compared in between. Comparison of proportions was used as the statistical analysis method. Results: The study totally included 169 cases, 54 with sustained NT, 66 with WCH, and 49 with HT. The 115 patients with WCH and HT were both diagnosed via HBP and ABPM, and no difference was observed between the two methods for the diagnosis of WCH and masked or obvious HT. Except the smoking and overweight, almost all of the above disorders showed a stepwise and significant progression in frequencies from sustained NT toward WCH and HT. Conclusions: WCH should preferentially be accepted as a disorder associated with a greater all-cause mortality, rather than a predisposing factor of HT or atherosclerosis alone, and its management should be focused on the above comorbid disorders.

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Section: Introductionmentioning

confidence: 99%

White Coat Hypertension Is Associated with a Greater All-cause Mortality

Helvacı

Kaya

Seyhanli

et al. 2007

JOURNAL OF HEALTH SCIENCE

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“…1,2) It was reported in the Ohasama study that WCH is a risk factor for development of home hypertension (HT).…”

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What Is the Relationship Between White Coat Hypertension and Dyslipidemia?

et al. 2008

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SUMMARYThe prognostic significance of white coat hypertension (WCH) remains controversial. Consecutive patients (955 cases, 566 females) aged between 15 and 70 years were divided into 3 groups, those with sustained normotension (NT), WCH, and hypertension (HT), and the prevalences of obesity, impaired glucose tolerance (IGT) or type 2 diabetes mellitus (DM), coronary heart disease (CHD), and dyslipidemia were compared among the groups. Although the prevalences of all of the disorders showed significant progression from the sustained NT group towards the WCH and HT groups, the prevalence of dyslipidemia was significantly higher in the WCH group (P < 0.05 for all). Due to the gradually increased prevalences of obesity, IGT or DM, and CHD from the sustained NT group towards the WCH and HT groups and the highest prevalence of dyslipidemia in the WCH group, WCH should preferentially be accepted as an alarming sign of a deterioration in health rather than being a predisposing factor of HT or atherosclerosis alone. The significantly higher prevalence of dyslipidemia in the WCH group than in the HT group may be explained by the increased amount of adipose tissue in the HT cases, since the prevalence of obesity was the highest in the HT group. Thus, the high prevalence of WCH even in early decades may represent increased susceptibility to future weight gain, and dyslipidemia in patients with WCH may be a preliminary sign of obesity. Therefore, the management of WCH should focus on the prevention of dyslipidemia and excess weight gain. (Int Heart J 2008; 49: 87-93)

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“…4 -6,8 Second, transition rates for the incidence of new hypertension in those with WCH can be more accurately estimated. 16 Third, in the United States, the charges for ABPM are somewhat fixed by Centers for Medicare and Medicaid Services policies and are relatively low. Costs for treatment of hypertension can be estimated from various sources, including those from managed care organizations.…”

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confidence: 99%

Cost-Effectiveness of Ambulatory Blood Pressure

Krakoff

2006

Hypertension

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Abstract-Accurate diagnosis of hypertension and prognosis for future cardiovascular events can be enhanced through the use of 24-hour ambulatory blood pressure monitoring. It has been suggested that the use of ambulatory monitoring as a secondary screening for hypertension might be cost-effective. Many needed studies that are related to the calculation of costeffectiveness for ambulatory monitoring have become available in recent years. More accurate estimates for cost of care, costs for testing, prevalence of white-coat hypertension, and incidence of the transition from normal pressures to hypertension have been reported. This study presents calculations of the cost savings likely to take place when ambulatory blood pressure monitoring is implemented for newly detected hypertensive subjects. These calculations are based on current estimates for cost of testing, cost of treatment, prevalence of white-coat hypertension at baseline, and varying the incidence of new hypertension after the initial screening. The results indicate a potential savings of 3% to 14% for cost of care for hypertension and 10% to 23% reduction in treatment days when ambulatory blood pressure monitoring is incorporated into the diagnostic process. At current reimbursement rates, the cost of ambulatory blood pressure monitoring for secondary screening on an annual basis would be Ͻ10% of treatment costs. Calculated savings for use of ambulatory blood pressure monitoring can take place when annual treatment costs are as little as $300. These estimates should be considered for the management of recently detected hypertension, especially when the risk of future cardiovascular is disease is low. Key Words: ambulatory blood pressure monitoring, ambulatory Ⅲ hypertension, white-coat Ⅲ cost benefit analysis P rospective surveys have established the value of ambulatory blood pressure monitoring (ABPM), compared with, or additive to, clinic pressures, for predicting the risk of fatal and nonfatal cardiovascular disease in hypertensive groups. [1][2][3][4][5][6] The use of ABPM for untreated hypertensive patients, initially detected by clinic pressures, to define those with lower daytime and/or 24-hour average pressures has led to the concept of white-coat hypertension (WCH). 7 Pooled results from several prospective observational studies have shown that the likelihood for future stroke in WCH is nearly that of normal subjects for 5-year follow-up intervals. 8 WCH hypertension may also be related to a more favorable overall cardiovascular risk profile reflected by lower body mass index and favorable serum lipid patterns. 9 These findings support recommendations in current guidelines that ABPM be used in the management of hypertension. 10 -12 ABPM is well tolerated by patients in primary care practices who consider the information provided to be helpful for their management. 13 Additional recognition of the value of ABPM has been the approval for reimbursement by the Center for Medicare and Medicaid Services of the United States (CMS).When ABPM became av...

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Sequential follow-up clinic and ambulatory blood pressure evaluation in a low risk population of white-coat hypertensive patients and in normotensives

Cited by 30 publications

References 36 publications

White Coat Hypertension Is Associated with a Greater All-cause Mortality

White Coat Hypertension Is Associated with a Greater All-cause Mortality

What Is the Relationship Between White Coat Hypertension and Dyslipidemia?

Cost-Effectiveness of Ambulatory Blood Pressure

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