Key result
Treated white coat hypertension and masked hypertension in patients with diabetes were associated with significantly increased cardiovascular risk compared to well-controlled non-diabetic patients (HR 2.73 and 2.77, respectively).
Why the study?
Does treated white coat and masked hypertension increase cardiovascular risk in hypertensive patients with diabetes or chronic kidney disease?
Observational (n=21,591)
Yes
Does treated white coat and masked hypertension increase cardiovascular risk in hypertensive patients with diabetes or chronic kidney disease?
Hazard Ratio: 2.73
Absolute Event Rate: 10.77% vs 3.15%
p-value: p=<0.05
Treated white coat and masked hypertension are associated with increased cardiovascular risk in patients with diabetes or chronic kidney disease, emphasizing the need to control both home and clinic blood pressure.
Treated white coat and masked hypertension may raise CV risk in diabetes; hypothesis-generating for out-of-office BP targets, should not yet change practice.
The prognostic implications of treated white coat hypertension (WCH) and masked hypertension (MH) in patients with diabetes mellitus (DM) or chronic kidney disease (CKD) are not well documented. Using data from the HONEST study (n=21 591), we investigated the relationships between morning home systolic blood pressure (MHSBP) or clinic systolic blood pressure (CSBP) and cardiovascular (CV) risk in hypertensive patients with and without DM or CKD receiving olmesartan-based antihypertensive therapy. The study included 4426 DM patients and 4346 CKD patients at baseline who had 101 and 87 major CV events, respectively, during the follow-up. Compared with well-controlled non-DM patients (MHSBP <135 mm Hg; CSBP <140 mm Hg), DM patients with WCH (MHSBP <135 mm Hg; CSBP ⩾140 mm Hg), MH (MHSBP ⩾135 mm Hg; CSBP <140 mm Hg) or poorly controlled hypertension (PCH) (MHSBP ⩾135 mm Hg; CSBP ⩾140 mm Hg) had significantly higher CV risk (hazard ratio (HR), 2.73, 2.77 and 2.81, respectively). CV risk was also significantly increased in CKD patients with WCH, MH and PCH (HR, 2.14, 1.70 and 2.20, respectively) compared with well-controlled non-CKD patients. Furthermore, DM patients had significantly higher incidence rate than non-DM patients of MHSBP ⩾125 to <135 mm Hg (HR, 1.98) and ⩾135 to <145 mm Hg (HR, 2.41). In conclusion, both WCH and MH are associated with increased CV risk, and thus control of both MHSBP and CSBP is important to reduce CV risk in DM or CKD patients. The results also suggest that even lower MHSBP (<125 mm Hg) may be beneficial for DM patients, although this conclusion is limited by the small number of patients.
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Kushiro et al. (2016) conducted an observational in Hypertension with and without diabetes mellitus or chronic kidney disease (n=21,591). White coat hypertension (WCH) and masked hypertension (MH) vs. Well-controlled hypertension (CH) in non-diabetic patients was evaluated on First occurrence of a major cardiovascular event (composite of stroke, cardiac events, and sudden death) (HR 2.73, p=<0.05). Treated white coat hypertension and masked hypertension in patients with diabetes were associated with significantly increased cardiovascular risk compared to well-controlled non-diabetic patients (HR 2.73 and 2.77, respectively).
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