Title: Setting thresholds to varying blood pressure monitoring intervals differentially affects risk estimates associated with white-coat and masked hypertension in the population
Authors: Asayama, Kei
Thijs, Lutgarde
Li, Yan
Gu, Yumei
Hara, Azusa
Liu, Yan-Ping
Zhang, Zhenyu
Wei, Fangfei
Lujambio, Inés
Mena, Luis J
Boggia, José
Hansen, Tine W
Björklund-Bodegård, Kristina
Nomura, Kyoko
Ohkubo, Takayoshi
Jeppesen, Jørgen
Torp-Pedersen, Christian
Dolan, Eamon
Stolarz-Skrzypek, Katarzyna
Malyutina, Sofia
Casiglia, Edoardo
Nikitin, Yuri
Lind, Lars
Luzardo, Leonella
Kawecka-Jaszcz, Kalina
Sandoya, Edgardo
Filipovský, Jan
Maestre, Gladys E
Wang, Jiguang
Imai, Yutaka
Franklin, Stanley S
O'Brien, Eoin
Staessen, Jan A ×
International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes (IDACO) Investigators #
Issue Date: Nov-2014
Publisher: Lippincott Williams & Wilkins
Series Title: Hypertension vol:64 issue:5 pages:935-42
Article number: 10.1161/HYPERTENSIONAHA.114.03614
Abstract: Outcome-driven recommendations about time intervals during which ambulatory blood pressure should be measured to diagnose white-coat or masked hypertension are lacking. We cross-classified 8237 untreated participants (mean age, 50.7 years; 48.4% women) enrolled in 12 population studies, using ≥140/≥90, ≥130/≥80, ≥135/≥85, and ≥120/≥70 mm Hg as hypertension thresholds for conventional, 24-hour, daytime, and nighttime blood pressure. White-coat hypertension was hypertension on conventional measurement with ambulatory normotension, the opposite condition being masked hypertension. Intervals used for classification of participants were daytime, nighttime, and 24 hours, first considered separately, and next combined as 24 hours plus daytime or plus nighttime, or plus both. Depending on time intervals chosen, white-coat and masked hypertension frequencies ranged from 6.3% to 12.5% and from 9.7% to 19.6%, respectively. During 91 046 person-years, 729 participants experienced a cardiovascular event. In multivariable analyses with normotension during all intervals of the day as reference, hazard ratios associated with white-coat hypertension progressively weakened considering daytime only (1.38; P=0.033), nighttime only (1.43; P=0.0074), 24 hours only (1.21; P=0.20), 24 hours plus daytime (1.24; P=0.18), 24 hours plus nighttime (1.15; P=0.39), and 24 hours plus daytime and nighttime (1.16; P=0.41). The hazard ratios comparing masked hypertension with normotension were all significant (P<0.0001), ranging from 1.76 to 2.03. In conclusion, identification of truly low-risk white-coat hypertension requires setting thresholds simultaneously to 24 hours, daytime, and nighttime blood pressure. Although any time interval suffices to diagnose masked hypertension, as proposed in current guidelines, full 24-hour recordings remain standard in clinical practice.
ISSN: 0194-911X
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Department of Cardiovascular Sciences - miscellaneous
Hypertension and Cardiovascular Epidemiology
× corresponding author
# (joint) last author

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