What is the clinical evidence from this study?

Study design: Observational. Population: Hypertension (n=967). Intervention: Ambulatory blood pressure monitoring (ABPM) vs. Clinic blood pressure. Primary outcome: Prevalence of white-coat hypertension (WCHT) and masked hypertension (MHT).

January 1, 2007Open Access

Prevalence, Predictive Factor, and Clinical Significance of White-Coat Hypertension and Masked Hypertension in Korean Hypertensive patients

Key Result

Ambulatory blood pressure monitoring revealed a 28.2% prevalence of white-coat hypertension and a 5.7% prevalence of masked hypertension among 967 Korean patients with newly diagnosed hypertension.

Study Design

Type

Observational (n=967)

Multicenter

Structured PICO

What is the prevalence, predictive factors, and clinical significance of white-coat and masked hypertension in Korean hypertensive patients?

Population

967 Korean patients aged 15 years or older with newly diagnosed hypertension, free of serious cardiovascular complications, who underwent 24-hour ambulatory blood pressure monitoring.

Exposure

24-hour ambulatory blood pressure monitoring (ABPM)

Outcome

Prevalence of white-coat hypertension (WCHT) and masked hypertension (MHT), predictive factors, and target organ damage (left ventricular mass index)surrogate

White-coat and masked hypertension are prevalent in Korean hypertensive patients, and 24-hour ambulatory blood pressure monitoring is essential for accurate diagnosis and assessment of target organ damage.

Limitations

Retrospective design rather than a random prospective study
Fewer young patients were included, which may not reflect primary medical practice
Relatively low number of patients in each subgroup for left ventricular hypertrophy comparisons
Clinic blood pressure was measured only once, potentially introducing errors in the diagnosis of white-coat hypertension
Potential ABPM effect where average blood pressure increases for the first four hours after wearing the device

Abstract

BACKGROUND: The prevalence and clinical significance of white-coat hypertension (WCHT) and masked hypertension (MHT) are unknown in Koreans. Here we measure the frequency of WCHT and MHT in hypertensive subjects and identify the epidemiologic and/or clinical factors that predict it in Korean subjects. METHODS: This study is a retrospective analysis of a random sample from February 2004 to October 2005. All patients had measurements of blood pressure (BP) in the clinic and 24-hour ambulatory blood pressure monitoring (ABPM). Subjects were classified into four groups on the basis of daytime ambulatory BP and clinic BP level: 1) Normotension (NT), 2) MHT, 3) WCHT, and 4) sustained hypertension (SHT). RESULTS: For all 967 patients, the mean clinic BP was 157.7 +/- 22.0/ 95.3 +/- 13.1 mmHg, and the mean daytime ambulatory BP was 136.4 +/- 15.0/ 86.2 +/- 10.7 mmHg. The NT, MHT, WCHT, and SHT groups consisted of 51 (5.3%), 55 (5.7%), 273 (28.2%), and 588 (60.8%) subjects, respectively. The left ventricular mass index was significantly higher in SHT than in the other groups, and was positively correlated with BP, especially ABPM. Compared with NT, the factors associated with MHT were younger age, male gender, higher BMI, clinic BP > or = 130 mmHg, and alcohol consumption. Compared with SHT, the factors associated with WCHT were female gender, lower BMI, and clinic BP < 150 mmHg. CONCLUSIONS: WCHT and MHT were prevalent in the hypertensive population. ABPM was more predictive of target organ damage than clinic BP, and could be useful in identifying subjects at risk for WCHT and MHT.

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