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.
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?
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.
Hazard Ratio: 2.13 (95% CI 1.38–3.29)
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 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.
“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.”
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.