The importance of using 24‐hour and nighttime blood pressure for the identification of white coat hypertension: Data from the Jackson Heart Study

Anstey, D. Edmund; Colantonio, Lisandro D.; Yano, Yuichiro; Booth, John N.; Muntner, Paul

doi:10.1111/jch.13330

Cited by 12 publications

(10 citation statements)

References 21 publications

(45 reference statements)

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“…In contrast, in our study at baseline anthropometric and biochemical characteristics and percentage of smokers of our WCHT population did not differ from that of normotensives which may also explain the relatively benign outcome and the lower percentage of transition to SHT of our WCHT population. Nevertheless, our data still support the prudent recommendations [ 1 , 22 , 32 , 34 ] in relation to this entity of close surveillance with a frequent BP measurement outside the office. Since 24 h-ABPM enlightens the nighttime BP values, it is the preferential tool for the definition of WCHT unless new devices to home BP able to register the NBP will become available.…”

Section: Discussionsupporting

confidence: 77%

“…In general, a better prognosis of WCHT should be expected when normal NBP values are included in the definition of WCHT since NBP is a stronger predictor of risk than daytime BP [ 25 ]. In fact, a lower prevalence rate of WCHT [ 6 , 34 – 36 ] and a lower value of left ventricular mass index [ 29 ] were found when normal values of daytime and nighttime BP values were considered together in the classification of WCHT compared with the condition of including daytime BP only. Moreover, the prevalence of WCHT was reduced when NBP was used for its categorization [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Risk of Progression to Sustained Hypertension in White-Coat Hypertension with Normal Night-Time Blood Pressure Values

Faria

Mesquita-Bastos

Bertoquini

et al. 2020

International Journal of Hypertension

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Background. The long-term prognosis and transition towards sustained ambulatory hypertension (SHT) of white-coat hypertension (WCHT) remain uncertain particularly in those with both normal nighttime and daytime blood pressure (BP) values. Different classification criteria and the use of antihypertensive drugs may contribute to conflicting results. Patients and Methods. We prospectively evaluated for a 7.1 year transition to SHT in 899 nondiabetic subjects free from cardiovascular (CV) events: normotensive (NT) (n = 344; 52, 9% female; ageing 48 ± 14 years); untreated WCHT (UnWCHT n = 399; 50, 1% female; ageing 51 ± 14 years); and treated WCHT with antihypertensive drugs after baseline (TxWCHT n = 156; 54, 4% female; ageing 51 ± 15 years). All underwent 24 h ambulatory BP monitoring (24 h-ABPM) at baseline, at 30 to 60 months, and at 70 to 120 months thereafter. WCHT was at baseline (with no treatment) as office BP ≥ 140/or 90 mm·Hg, daytime BP < 135/85 mm·Hg, and nighttime BP < 120/70 mm·Hg. Development of SHT was considered if daytime BP ≥ 135/or 85 mm Hg and/or nighttime BP ≥ 120/or 70 mm·Hg. Results. Baseline metabolic parameters did not differ among groups. At 30–60 months and at the end of follow-up, development of SHT occurred, respectively, in NT (3.8% (n = 13) and 9.6% (n = 33)) and in UnWCHT (10.1% (n = 40) and 16.5% (n = 66)) ( p < 0.009 ). The mean annual increase of average 24 h-systolic BP was 0.48 + 0.93 in NT and 0.73 + 1.06 in UnWCHT, whereas annual SBP in office increased in NT by 1.2 + 0.95 but decreased in UnWCHT by 1.36 + 1.35 mm Hg ( p < 0.01 ). Conclusion. Untreated WCHT patients exhibit a faster and a higher risk of developing SHT compared to NT with TxWCHT assuming an intermediate position between them.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Long-Term Risk of Progression to Sustained Hypertension in White-Coat Hypertension with Normal Night-Time Blood Pressure Values

Faria

Mesquita-Bastos

Bertoquini

et al. 2020

International Journal of Hypertension

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“…For the ambulatory blood pressure, the daytime average blood pressure was ≥135/85 mm Hg, the nighttime average blood pressure was ≥120/70 mm Hg, and the 24‐hours average blood pressure was ≥130/80 mm Hg. The four groups were as follows: SHT, participants with elevated clinic and ambulatory blood pressures; WCH, participants with elevated clinic and normal ambulatory blood pressures; MHT, participants with normal clinic and elevated ambulatory blood pressures; and NT, participants with normal clinic and ambulatory blood pressures …”

Section: Participants and Methodsmentioning

confidence: 99%

Association of thyroid function with white coat hypertension and sustained hypertension

Cai

Peng

Chen

et al. 2019

J of Clinical Hypertension

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This study aimed to explore the relationship of thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) levels with hypertension subtypes. 1056 euthyroid adults were included as research samples. They underwent measurement of clinic blood pressure and 24-hours ambulatory blood pressure monitoring. Then, they were divided into normotension (NT), white coat hypertension (WCH), masked hypertension (MHT), and sustained hypertension (SHT) groups. The 24-hours dynamic electrocardiogram was performed to analyze the heart rate variability (HRV), so as to reflect the cardiac autonomic function. The relationship between hypertension subtypes, thyroid function, and HRV was analyzed. The TSH concentration was significantly higher in the SHT group than in the NT group (P = 0.001). The FT3 concentration was higher in the SHT group than in the NT and MHT groups (P = 0.013, P = 0.008), while the FT4 concentration was significantly higher in the WCH group than in the NT group (P = 0.002). The changes in HRV were observed between the SHT, WCH, and MHT groups and the NT groups, as well as between the SHT and the MHT groups. The multiple linear regression analysis also showed that FT3, HRV (RMSSD and PNN50), and blood pressure levels linearly correlated with one another (P < 0.05). Meanwhile, the linear regression analysis showed a linear negative correlation between FT4 and HRV (SDANN) in the WCH + NT group (P = 0.001). Thyroid function was closely related to hypertension subtypes such as WCH probably due to the changes in the cardiac autonomic function. | 675 CAI et Al.

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“…The article by Anstey et al, published in the present issue of the Journal of Clinical Hypertension , may help yield further evidence to unravel the dispute. In their study, based on a relatively large sample of black individuals in the community‐based prospective cohort Jackson Heart Study, the authors showed that the prevalence of WCH may substantially vary according to the periods of the 24 hours used for classification.…”

Section: Current Definitions Of Wch According To Major Hypertension Gmentioning

confidence: 99%

A working definition of white‐coat hypertension must include nocturnal blood pressure

Omboni

2018

J of Clinical Hypertension

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The term white-coat hypertension (WCH) refers to a condition characterized by an elevation of blood pressure (BP) in the office with normal ambulatory or home values. Previous studies have estimated a prevalence of this condition ranging from 15-20% to 40-50% of individuals with elevated office BP. A controversy currently exists on whether WCH is a benign phenomenon and how it should be best defined. Some studies suggest that patients with the condition have a risk of cardiovascular events similar to patients with normotension, whereas others document an increased rate of target organ damage and cardiovascular events. 1 In some patients, WCH may deteriorate to persistent hypertension in the future, leading to the risk of cardiovascular events as a long-term outcome. Individuals with high-normal BP, additional cardiovascular risk factors (eg, obesity, metabolic syndrome, advanced age, and impaired glucose tolerance), and organ damage may be particularly susceptible to a poor prognosis in the presence of WCH. According to two recent meta-analyses, WCH is associated with a slightly increased risk of cardiovascular events compared with normotension, although this risk is well below that seen in either persistent hypertension or masked hypertension. Briasoulis et al 2 analyzed 14 studies with 29 100 participants and showed that individuals with WCH had higher rates of cardiovascular disease morbidity and mortality but not significantly different all-cause mortality and stroke risk compared with patients with normotension. Huang et al 3 analyzed 23 cohorts of 20 445 untreated individuals, 11 cohorts of 8656 treated individuals, and a mixed population including both treated and untreated patients (12 cohorts, 21 336 individuals) and concluded that WCH is associated with long-term risk of cardiovascular disease and total mortality in untreated and mixed populations but not in treated patients. All of the studies included in these meta-analyses based categorization of WCH either on ambulatory or home BP. In case of ambulatory BP, the most common definition of WCH was based on daytime BP only, thus excluding nighttime BP. However, many people have normotension during waking hours and hypertension during night sleep, and may thus be mistakenly classified as having WCH. Yet, there are few data comparing the prevalence and consequences of using daytime (awake), full 24hour, rather than nighttime (sleep), periods to define WCH. In fact, heterogeneity among recommendations from the different guidelines exists and there is currently controversy on which period of the day is most suitable for defining WCH (Table 1). The article by Anstey et al, 11 published in the present issue of the Journal of Clinical Hypertension, may help yield further evidence to unravel the dispute. In their study, based on a relatively large sample of black individuals in the community-based prospective cohort Jackson Heart Study, the authors showed that the prevalence of WCH may substantially vary according to the periods of the 24 hours used for classif...

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The importance of using 24‐hour and nighttime blood pressure for the identification of white coat hypertension: Data from the Jackson Heart Study

Cited by 12 publications

References 21 publications

Long-Term Risk of Progression to Sustained Hypertension in White-Coat Hypertension with Normal Night-Time Blood Pressure Values

Long-Term Risk of Progression to Sustained Hypertension in White-Coat Hypertension with Normal Night-Time Blood Pressure Values

Association of thyroid function with white coat hypertension and sustained hypertension

A working definition of white‐coat hypertension must include nocturnal blood pressure

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