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

Figures

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  Fig. 1. Schematic description of the study population. This study included patients taking antihypertensive medications who had records of clinical BP and antihypertensive drugs and underwent valid ABPM. The study population (n = 1,601) was categorized into four hypertension phenotypes: CH, WUCH, MUCH, and UCH, using two different clinic BP targets: intensive (clinic BP < 130/80 mmHg) and conventional (clinic BP < 140/90 mmHg). BP = blood pressure, ABPM = ambulatory blood pressure monitoring, CH = controlled hypertension, WUCH = white-coat uncontrolled hypertension, MUCH = masked uncontrolled hypertension, UCH = uncontrolled hypertension, ABP = ambulatory blood pressure.

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  Fig. 2. Prevalence of hypertension phenotype based on 2 different clinic BP targets. (A) In all hypertension phenotypes, the prevalence of MUCH decreased markedly while the prevalence of WUCH increased modestly when the intensive clinic BP target, rather than the conventional one, was applied. (B) Among patients achieving the clinic BP target, the prevalence of MUCH decreased by > 30%, when the intensive target was applied. (C) Among patients not achieving the clinic BP target, the prevalence of WUCH increased by only < 4%, when the clinic BP target changed from the conventional to intentional target. BP = blood pressure, MUCH = masked uncontrolled hypertension, WUCH = white-coat uncontrolled hypertension, UCH = uncontrolled hypertension, CH = controlled hypertension.

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  Fig. 3. Concordance between the achievement of clinic BP target and the controlled ABP in 2 different clinic BP targets. The size of the circles represents the number of patients in each category. The Cohen's Kappa (K) values indicate the level of agreement between the clinic BP target achievement and the controlled ABP is moderate in the conventional target cohort (K = 0.46 [0.41–0.50]), while substantial in the intensive target cohort (K = 0.62 [0.58–0.67]). BP = blood pressure, ABP = ambulatory blood pressure, CH = controlled hypertension, WUCH = white-coat uncontrolled hypertension, MUCH = masked uncontrolled hypertension, UCH = uncontrolled hypertension.

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  Fig. 4. Univariate logistic regression models for the predictors of MUCH and WUCH in 2 different clinic BP targets. (A) When the intensive clinic BP target was applied, BMI and LVMI were significant predictors of MUCH, while lower clinic SBP and DBP and lower LVMI were significant predictors of WUCH. (B) When the conventional clinic BP target was applied, higher clinic SBP and DBP, male sex, BMI, central obesity, current alcohol intake, antihypertensive drugs < 2 and LVMI were significant predictors of MUCH, while lower clinic SBP and underuse of ARB were significant predictors of WUCH. MUCH = masked uncontrolled hypertension, WUCH = white-coat uncontrolled hypertension, BP = blood pressure, BMI = body mass index, LVMI = left ventricular mass index, SBP = systolic blood pressure, DBP = diastolic blood pressure, ARB = angiotensin receptor blocker, ACEI = angiotensin-converting enzyme inhibitor, eGFR = estimated glomerular filtration rate.

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  Fig. 5. Illustration for the relationship between the mean ABP and clinic BP in the determination of hypertension phenotypes. Hypertension phenotypes exist because of the discrepancies between clinic BP and ABP. These illustrations represent the relationship between clinic BP and ABP in the hypertension phenotype. The vertical division represents clinic BP target achievement, and the diagonal division represents the true control of BP. For extreme clinic BP targets, it is difficult for MUCH and WUCH to exist. Model A represents linear changes in the proportions of hypertension phenotypes where no optimal clinic BP target exists, whereas Model B represents nonlinear changes in the proportions of hypertensive phenotypes according to the clinic BP targets, where an optimal clinic BP target exists. ABP = ambulatory blood pressure, BP = blood pressure, MUCH = masked uncontrolled hypertension, WUCH = white-coat uncontrolled hypertension, UCH = uncontrolled hypertension, CH = controlled hypertension.