White-coat effect and masked hypertension in patients with high-normal office blood pressure: results of the Hungarian ABPM Registry

Abstract

Objective: Blood pressure (BP) lowering therapy in hypertension can markedly reduce the risk of cardiovascular diseases. In case of high-normal office blood pressure (oBP), the initiation of antihypertensive medication is recommended by guidelines in patients with very high cardiovascular risk. The aims of this study were to evaluate the presence of white-coat high-normal BP (WhHNBP) and masked hypertension in high-normal oBP and to explore the prevalence of untreated very high cardiovascular risk patients. Methods: Data of the Hungarian Ambulatory Blood Pressure Monitoring (ABPM) Registry between September 2020 and November 2023 were used in our analysis. Results: From 38 720 uploaded ABPM curves with clinical data, 4300 individuals were categorized as having high-normal oBP. Among those, 3285 (76.4%) were on antihypertensive treatment. Based on the ABPM recordings, high-normal BP was confirmed in 20.5% (n = 881), while WhHNBP was present in 27.6% (n = 1188) and masked hypertension in 51.9% (n = 2231). Similar results were found in treated and untreated subjects or patients as well. Independent predictors of WhHNBP were age [odds ratio (OR) 1.02 (95% confidence interval, 95% CI: 1.01–1.02), P < 0.001], female sex [OR: 1.59 (1.32–1.92), P < 0.001] and snoring [OR: 0.70 (0.57–0.86), P < 0.001]. Independent predictors of masked hypertension were male sex [OR: 1.31 (1.12–1.54), P < 0.001] and obesity [OR: 1.71 (1.39–2.09), P < 0.001]. Five hundred and two individuals had very high cardiovascular risk with high-normal oBP and only 25 of them were untreated. Conclusion: In high-normal oBP, WhHNBP or masked hypertension is present in three out of four individuals. Most of the patients with high-normal oBP and very high cardiovascular risk are already treated with antihypertensive drugs.