Key result
Applying night-time ambulatory blood pressure thresholds to patients with white-coat and white-coat uncontrolled hypertension revealed nocturnal hypertension in 26.9% and 31.8% of cases.
Why the study?
The impact of defining white-coat hypertension and white-coat uncontrolled hypertension based on daytime and night-time thresholds of ambulatory blood pressure, rather than 24-h mean values, is unclear.
Does reclassifying white-coat hypertension based on diurnal and nocturnal ABPM thresholds identify adverse BP phenotypes missed by 24-h mean values?
Observational (n=3,223)
No
Does reclassifying white-coat hypertension based on diurnal and nocturnal ABPM thresholds identify adverse BP phenotypes missed by 24-h mean values?
Classifying white-coat hypertension using only 24-hour mean BP fails to detect nocturnal hypertension in approximately 30% of patients, highlighting the need for specific daytime and night-time thresholds.
Should not yet change white-coat hypertension classification; leaves open whether night-time thresholds improve risk stratification.
AIM: The impact of defining white-coat hypertension (WCH) and white-coat uncontrolled hypertension (WCUH) based on daytime and night-time thresholds of ambulatory blood pressure (ABP), instead of 24-h mean value, is unclear. We aimed to reclassify BP status according to both diurnal and nocturnal thresholds in a large sample of hypertensive patients seen in a specialist center and previously classified as WCH and WCUH based on 24-h BP values. METHODS: A data-base of 7353 individual 24-h ABP monitoring (ABPM) from untreated and treated hypertensive individuals with office BP at least 140 mmHg and/or 90 mmHg was analysed and a subset of 3223 patients characterized by mean 24-h BP less than 130/80 mmHg (i.e. WCH and WCUH) was included in the present analysis. RESULTS: As many as 1281 patients were classified as WCH and 1942 as WCUH. Among them, elevated out-of-office BP according to night-time threshold (i.e. ≥120/70 mmHg) was found in about 30% of cases. In particular, prevalence rates of nocturnal hypertension were 26.9% in WCH and 31.8% in WCUH. Isolated daytime hypertension (i.e. ≥135/85 mmHg) was detected in an additional 4% of individuals. CONCLUSION: Classification of WCH and WCUH based on mean 24-h BP thresholds does not allow to detect an adverse BP phenotype, such as nocturnal hypertension in a large fraction of untreated and treated patients.
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Cuspidi et al. (2020) conducted an observational in White-coat hypertension and white-coat uncontrolled hypertension (n=3,223). Night-time ambulatory blood pressure threshold (≥120/70 mmHg) vs. 24-h mean ambulatory blood pressure threshold was evaluated on Prevalence of nocturnal hypertension. Applying night-time ambulatory blood pressure thresholds to patients with white-coat and white-coat uncontrolled hypertension revealed nocturnal hypertension in 26.9% and 31.8% of cases.
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