Key result
Masked but not white-coat hypertension linked to ~113% greater cardiovascular risk versus normal BP.
Why the study?
The prognostic significance of white-coat hypertension remained controversial, and little was known about the prognosis of masked hypertension.
Does masked hypertension or white-coat hypertension increase the risk of cardiovascular mortality and stroke morbidity compared to sustained normal BP in the general population?
Cohort (n=1,332)
Does masked hypertension or white-coat hypertension increase the risk of cardiovascular mortality and stroke morbidity compared to sustained normal BP in the general population?
Hazard Ratio: 2.13 (95% CI 1.38–3.29)
Masked hypertension, but not white-coat hypertension, carries a significantly increased risk of cardiovascular mortality and stroke comparable to sustained hypertension, emphasizing the prognostic value of ambulatory BP monitoring.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The BP level may have been decreased coincidently during the single-office BP measurement owing to BP variability. In addition, one-third of the subjects classified as masked hypertensive received antihypertensive treatment and may have taken their medication a few hours before the visit, leading to decreased BP levels at the time of measurement.”
“The cardiovascular risks associated with masked hypertension approach that of sustained hypertension and exceed that associated with white-coat hypertension.”
“The prognosis of patients with masked hypertension is at least comparable to that of patients with sustained hypertension.”
Masked hypertension signals higher CV risk missed by office BP; leaves open whether ABPM-guided therapy improves outcomes.
OBJECTIVES: We sought to investigate the prognosis in subjects with "white-coat" hypertension (WCHT) and "masked" hypertension (MHT), in which blood pressure (BP) is lower in clinical measurements than during ambulatory monitoring. BACKGROUND: The prognostic significance of WCHT remains controversial, and little is known about MHT. METHODS: We obtained 24-h ambulatory BP and "casual" BP (i.e., obtained in clinical scenarios) values from 1,332 subjects (872 women, 460 men) > or =40 years old in a representative sample of the general population of a Japanese community. Survival and stroke morbidity were then followed up for a mean duration of 10 years. RESULTS: Composite risk of cardiovascular mortality and stroke morbidity examined using a Cox proportional hazards regression model for subjects with WCHT (casual BP > or =140/90 mm Hg, daytime BP <135/85 mm Hg; relative hazards [RH])1.28; 95% confidence interval [CI] 0.76 to 2.14) was no different from risk for subjects with sustained normal BP (casual BP <140/90 mm Hg, daytime BP <135/85 mm Hg). However, risk was significantly higher for subjects with MHT (casual BP <140/90 mm Hg, daytime BP > or =135/85 mm Hg; RH 2.13; 95% CI 1.38 to 3.29) or sustained hypertension (casual BP > or =140/90 mm Hg, daytime BP > or =135/85 mm Hg; RH 2.26; 95% CI 1.49 to 3.41) than for subjects with sustained normal BP. Similar findings were observed for cardiovascular mortality and stroke morbidity among subgroups by gender, use of antihypertensive medication, and risk factor level (all p for heterogeneity >0.2). CONCLUSIONS: Conventional BP measurements may not identify some individuals at high or low risk, but these people may be identifiable by the use of ambulatory BP.
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Ohkubo et al. (2005) conducted a cohort in White-coat and masked hypertension (n=1,332). Masked hypertension vs. Sustained normal blood pressure was evaluated on Composite risk of cardiovascular mortality and stroke morbidity (RH 2.13, 95% CI 1.38-3.29). Masked hypertension (RH 2.13; 95% CI 1.38-3.29), but not white-coat hypertension (RH 1.28; 95% CI 0.76-2.14), was associated with a higher risk of cardiovascular events than normal blood pressure.
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