What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension (n=1601). Intervention: Intensive clinic blood pressure target (< 130/80 mmHg) vs. Conventional clinic blood pressure target (< 140/90 mmHg). Primary outcome: Prevalence of masked uncontrolled hypertension (MUCH) among patients achieving the clinic BP target.

January 1, 2025Open Access

Impact of Clinic Blood Pressure Target on the Prevalence and Predictors of Masked Uncontrolled Hypertension and White-Coat Uncontrolled Hypertension

Q: What are the key findings of this study?

Adopting an intensive clinic blood pressure target (< 130/80 mmHg) significantly reduced the prevalence of masked uncontrolled hypertension to 15.5% compared to 45.8% with the conventional target.

Q: What does this research mean for the field?

Adopting an intensive clinic blood pressure target (< 130/80 mmHg) significantly reduces the prevalence of masked uncontrolled hypertension to 15.5% compared to 45.8% with the conventional target. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Adopting an intensive clinic blood pressure target (< 130/80 mmHg) significantly reduced the prevalence of masked uncontrolled hypertension to 15.5% compared to 45.8% with the conventional target.

Study Design

Type

Cross-Sectional (n=1,601)

Multicenter

Yes

Structured PICO

Does adopting an intensive clinic blood pressure target (< 130/80 mmHg) compared to a conventional target (< 140/90 mmHg) alter the prevalence and predictors of masked uncontrolled hypertension and white-coat uncontrolled hypertension?

Population

1,601 patients with hypertension treated with antihypertensive drugs from the Korean Ambulatory Blood Pressure registry, all with valid ambulatory blood pressure (ABP) records. Mean age 59.5 years, 54.7% male.

Intervention

Classification using an intensive clinic blood pressure target (< 130/80 mmHg)

Comparator

Classification using a conventional clinic blood pressure target (< 140/90 mmHg)

Outcome

Prevalence and predictors of masked uncontrolled hypertension (MUCH) and white-coat uncontrolled hypertension (WUCH)

Adopting an intensive clinic blood pressure target (< 130/80 mmHg) significantly reduces the prevalence of masked uncontrolled hypertension compared to conventional targets, offering a more accurate assessment of true blood pressure control.

Main Result

Absolute Event Rate: 15.5% vs 45.8%

Limitations

Cross-sectional design restricted the ability to speculate on causal relationships between clinic BP targets and the prevalence of MUCH and WUCH.
Study population consisted only of Korean patients from outpatient clinics, which may limit generalizability to other ethnic groups.
Clinic BP was measured only twice at a single time point, which may limit the accuracy and reproducibility of the BP assessment.
Reliance on 24-hour ABPM data may not fully capture variations in BP throughout the day or under different conditions.
Did not account for potential confounding factors, such as stress, dietary habits, or medication adherence.

Abstract

BACKGROUND: Identifying masked uncontrolled hypertension (MUCH) and white-coat uncontrolled hypertension (WUCH) without ambulatory blood pressure (ABP) monitoring is challenging. Recent literature advocates intensive blood pressure (BP) control, but standard guidelines still suggest a clinic BP threshold of ≥ 149/90 mmHg to diagnose hypertension. This study explored the impact of different clinic BP targets on the prevalence and predictors of MUCH and WUCH. METHODS: This multicenter prospective cohort study included 1,601 patients with hypertension from the Korean Ambulatory Blood Pressure registry, all with valid ABP records. Two clinic BP targets were evaluated: an intensive target (< 130/80 mmHg) and a conventional target (< 140/90 mmHg). Controlled hypertension was defined as a 24-hour mean ABP < 130/80 mmHg in patients treated with antihypertensive drugs who had a clinic BP below these targets. RESULTS: The prevalence of MUCH decreased significantly with the intensive target (15.5%) versus the conventional target (45.8%). In contrast, the prevalence of WUCH increased only marginally with the intensive targets. Most patients with MUCH (75.9%) had a clinic BP between 130/80 mmHg and 139/89 mmHg when MUCH was classified using the conventional target. For predicting MUCH, factors such as angiotensin-converting enzyme inhibitor use, body mass index, left ventricular mass index (LVMI), and use of ≥ 2 antihypertensive drugs were significant under the intensive target, whereas clinic BP, LVMI, alcohol intake, stroke history, and use of ≥ 2 antihypertensive drugs were relevant under the conventional target. CONCLUSION: Adopting the intensive clinic BP target (< 130/80 mmHg) notably reduced the prevalence of MUCH, with a slight increase in WUCH, offering a more accurate assessment of BP control than the conventional target.

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