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Title: Significance of White-Coat Hypertension in Older Persons With Isolated Systolic Hypertension: A Meta-Analysis Using the International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes Population
Authors: Franklin, Stanley S ×
Thijs, Lutgarde
Hansen, Tine W
Boggia, José
Kikuya, Masahiro
Björklund-Bodegård, Kristina
Ohkubo, Takayoshi
Jeppesen, Jørgen
Torp-Pedersen, Christian
Dolan, Eamon
Kuznetsova, Tatiana
Stolarz-Skrzypek, Katarzyna
Tikhonoff, Valérie
Malyutina, Sofia
Casiglia, Edoardo
Nikitin, Yuri
Lind, Lars
Sandoya, Edgardo
Kawecka-Jaszcz, Kalina
Imai, Yutaka
Wang, Jiguang
Ibsen, Hans
O'Brien, Eoin
Staessen, Jan A
on behalf of the International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes Investigators #
Issue Date: Mar-2012
Publisher: Lippincott Williams & Wilkins
Series Title: Hypertension vol:59 issue:3 pages:564-571
Abstract: The significance of white-coat hypertension in older persons with isolated systolic hypertension remains poorly understood. We analyzed subjects from the population-based 11-country International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes database who had daytime ambulatory blood pressure (BP; ABP) and conventional BP (CBP) measurements. After excluding persons with diastolic hypertension by CBP (≥90 mm Hg) or by daytime ABP (≥85 mm Hg), a history of cardiovascular disease, and persons <18 years of age, the present analysis totaled 7295 persons, of whom 1593 had isolated systolic hypertension. During a median follow-up of 10.6 years, there was a total of 655 fatal and nonfatal cardiovascular events. The analyses were stratified by treatment status. In untreated subjects, those with white-coat hypertension (CBP ≥140/<90 mm Hg and ABP <135/<85 mm Hg) and subjects with normal BP (CBP <140/<90 mm Hg and ABP <135/<85 mm Hg) were at similar risk (adjusted hazard rate: 1.17 [95% CI: 0.87-1.57]; P=0.29). Furthermore, in treated subjects with isolated systolic hypertension, the cardiovascular risk was similar in elevated conventional and normal daytime systolic BP as compared with those with normal conventional and normal daytime BPs (adjusted hazard rate: 1.10 [95% CI: 0.79-1.53]; P=0.57). However, both treated isolated systolic hypertension subjects with white-coat hypertension (adjusted hazard rate: 2.00; [95% CI: 1.43-2.79]; P<0.0001) and treated subjects with normal BP (adjusted hazard rate: 1.98 [95% CI: 1.49-2.62]; P<0.0001) were at higher risk as compared with untreated normotensive subjects. In conclusion, subjects with sustained hypertension who have their ABP normalized on antihypertensive therapy but with residual white-coat effect by CBP measurement have an entity that we have termed, "treated normalized hypertension." Therefore, one should be cautious in applying the term "white-coat hypertension" to persons receiving antihypertensive treatment.
ISSN: 0194-911X
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Hypertension and Cardiovascular Epidemiology
× corresponding author
# (joint) last author

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