Setting Thresholds to Varying Blood Pressure Monitoring Intervals Differentially Affects Risk Estimates Associated With White-Coat and Masked Hypertension in the Population
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Published:2014-11
Issue:5
Volume:64
Page:935-942
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ISSN:0194-911X
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Container-title:Hypertension
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language:en
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Short-container-title:Hypertension
Author:
Asayama Kei1, Thijs Lutgarde1, Li Yan1, Gu Yu-Mei1, Hara Azusa1, Liu Yan-Ping1, Zhang Zhenyu1, Wei Fang-Fei1, Lujambio Inés1, Mena Luis J.1, Boggia José1, Hansen Tine W.1, Björklund-Bodegård Kristina1, Nomura Kyoko1, Ohkubo Takayoshi1, Jeppesen Jørgen1, Torp-Pedersen Christian1, Dolan Eamon1, Stolarz-Skrzypek Katarzyna1, Malyutina Sofia1, Casiglia Edoardo1, Nikitin Yuri1, Lind Lars1, Luzardo Leonella1, Kawecka-Jaszcz Kalina1, Sandoya Edgardo1, Filipovský Jan1, Maestre Gladys E.1, Wang Jiguang1, Imai Yutaka1, Franklin Stanley S.1, O’Brien Eoin1, Staessen Jan A.1
Affiliation:
1. From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (K.A., L.T., Y.-M.G., A.H., Y.-P.L., Z.Z., F.-F.W., J.A.S.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., T.O., Y.I.); Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations,...
Abstract
Outcome-driven recommendations about time intervals during which ambulatory blood pressure should be measured to diagnose white-coat or masked hypertension are lacking. We cross-classified 8237 untreated participants (mean age, 50.7 years; 48.4% women) enrolled in 12 population studies, using ≥140/≥90, ≥130/≥80, ≥135/≥85, and ≥120/≥70 mm Hg as hypertension thresholds for conventional, 24-hour, daytime, and nighttime blood pressure. White-coat hypertension was hypertension on conventional measurement with ambulatory normotension, the opposite condition being masked hypertension. Intervals used for classification of participants were daytime, nighttime, and 24 hours, first considered separately, and next combined as 24 hours plus daytime or plus nighttime, or plus both. Depending on time intervals chosen, white-coat and masked hypertension frequencies ranged from 6.3% to 12.5% and from 9.7% to 19.6%, respectively. During 91 046 person-years, 729 participants experienced a cardiovascular event. In multivariable analyses with normotension during all intervals of the day as reference, hazard ratios associated with white-coat hypertension progressively weakened considering daytime only (1.38;
P
=0.033), nighttime only (1.43;
P
=0.0074), 24 hours only (1.21;
P
=0.20), 24 hours plus daytime (1.24;
P
=0.18), 24 hours plus nighttime (1.15;
P
=0.39), and 24 hours plus daytime and nighttime (1.16;
P
=0.41). The hazard ratios comparing masked hypertension with normotension were all significant (
P
<0.0001), ranging from 1.76 to 2.03. In conclusion, identification of truly low-risk white-coat hypertension requires setting thresholds simultaneously to 24 hours, daytime, and nighttime blood pressure. Although any time interval suffices to diagnose masked hypertension, as proposed in current guidelines, full 24-hour recordings remain standard in clinical practice.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Internal Medicine
Cited by
136 articles.
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