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Relationships between cardiovascular risk factors and white-coat hypertension diagnosed by home blood pressure recordings in a middle-aged population. J Hypertens 2021; 39:2009-2014. [PMID: 33973957 PMCID: PMC8452319 DOI: 10.1097/hjh.0000000000002888] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective: To study risk in white-coat hypertension (WCH) by measurement of coronary artery calcium score (CACS), carotid--femoral pulse-wave velocity (PWV) and carotid plaques. Methods: Cross-sectional population-based cohort with randomized selection of participants from Linköping, Sweden. An Omron m10-IT oscillometric device was used for clinic and home blood pressures (HBP) in the morning and evening for 1 week. Results: We recruited 5029 middle-aged and mainly defined WCH as SBP at least 140 mmHg and/or DBP at least 90 mmHg with HBP less than 135/85 mmHg. There were 2680 normotensive participants and 648 had WCH after exclusion of treated participants. More women (59.5%) than men (42.8%, P < 0.001) had WCH. We found higher prevalence of CACS greater than 100 compared with less than 100 (12.4 vs. 7.2%, P < 0.001), PWV (11.5 ± 1.5 vs. 10.4 ± 1.3 m/s, P < 0.001) and a higher prevalence of one or more carotid plaques (59.5 vs. 48%, P < 0.001) in participants with WCH than in normotension. Participants with WCH also had more dyslipidemia and higher glucose levels. Normotensive women scored lower on nervousness than women with WCH (P = 0.022). After matching of 639 participants with WCH to normotensive participants according to age, gender and systolic HBP the prevalence of a high CACS (12.1 vs. 8.6%, P = 0.003,) PWV (11.0 ± 0.068 vs. 11.5 ± 0.068 m/s, estimated marginal means ± SE, P < 0.001 by ANOVA) but not more carotid plaques (59.5 vs. 55.6%, P = 0.23), remained in the participants with WCH compared with the matched normotensive participants. Conclusion: WCH is particularly common in middle-aged women, and it displays metabolic dysfunction and increased prevalence of arteriosclerotic manifestations in both genders. As markers of increased cardiovascular risk were present also after matching normotensive and WCH participants according to systolic HBP, age and gender, the presence of WCH signals an increased cardiovascular risk burden that is not fully explained by elevated BP levels at home.
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Simonetti V, Comparcini D, Tomietto M, Pavone D, Flacco ME, Cicolini G. Effectiveness of a family nurse-led programme on accuracy of blood pressure self-measurement: A randomised controlled trial. J Clin Nurs 2021; 30:2409-2419. [PMID: 33872417 DOI: 10.1111/jocn.15784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/10/2021] [Accepted: 03/22/2021] [Indexed: 01/01/2023]
Abstract
AIMS AND OBJECTIVES To evaluate the effectiveness of a Family Nurse Practitioner (FNP)-led programme on the degree of adherence of current recommendations on home blood pressure self-measurement (HBPM) as compared to routine care and management. BACKGROUND HBPM plays an important role for monitoring hypertensive patients; however, patients' adherence to current guidelines is unsatisfactory. A nurse-led training programme in the community setting could be an effective strategy to achieve high level of patients' adherence to recommendations. DESIGN A multicentre randomised controlled trial was carried out from September 2016 to September 2017. METHODS In total, 170 patients were randomly allocated into the intervention group (n = 83) and the usual care (n = 87). All participants received usual care (written and verbal information on HBPM recommendations); subjects in the intervention group also received 1-hour training session on how to correctly self-measure BP. Clinical trial registration was done (ClinicalTrials.gov.: NCT04681703). The CONSORT checklist for randomised controlled trials was used in this study. RESULTS At baseline, the level of adherence to the recommendation was similar in the two groups (p < .05). After 1 month, the adherence significantly increased in the intervention group, where patients were more likely to measure BP at the same hour and from the same arm, in a quiet environment, with the back and uncovered arm supported and the legs uncrossed; recording BP more than once in each measurement session; keeping a diary of blood pressure measurements; use of the appropriate cuff and proper placement of the cuff; and resting for >5 min before performing the measurement (all p < .05). CONCLUSIONS The FNP-led programme is effective in improving patients' adherence to guidelines on the correct technique to self-measure BP at home. RELEVANCE TO CLINICAL PRACTICE This programme may be added to the existing interventions in the community setting or considered into specifically nurse-led hypertension management models.
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Affiliation(s)
| | - Dania Comparcini
- Azienda Ospedaliera Universitaria "Ospedali Riuniti" di Ancona, Ancona, Italy
| | - Marco Tomietto
- Regional Taskforce for Healthcare System Assessment, Direzione Centrale Salute, Politiche Sociali e Disabilità, Trieste, Italy.,Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | | | | | - Giancarlo Cicolini
- Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
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Ma H, Bian Y, Wang Y, Zhou C, Geng W, Zhang F, Liu J, Yang C. Exploring the effect of virtual reality relaxation environment on white coat hypertension in blood pressure measurement. J Biomed Inform 2021; 116:103721. [PMID: 33631382 DOI: 10.1016/j.jbi.2021.103721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
A phenomenon called White Coat Hypertension (WCH) often occurs when measuring blood pressure (BP) in a real medical environment. Utilizing virtual reality (VR) technology to present appropriate relaxation scenes can isolate the real medical environments and may provide a new method to avoid WCH and improve the accuracy of BP measurement. In this study, we designed four immersive VR relaxation scenes and conducted an experiment to explore the role of VR scenes in eliminating/detecting WCH in BP measurement. Results from the current sample showed that both systolic BP and diastolic BP measured in the simulated medical environment were significantly higher than the baseline level and the VR scene condition, while there were no significant differences between the BPs measured in VR scenes and the baseline level. It can be concluded that VR provides an effective approach to avoid WCH in BP measurement by visually and aurally isolating the real environment and assisting relaxation and provides a new approach to detect the occurrence of WCH by the comparison of BPs measured in the VR scene condition and real medical environments.
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Affiliation(s)
- Haokai Ma
- College of Software, Shandong University, Shandong, China
| | - Yulong Bian
- College of Software, Shandong University, Shandong, China; School of Mechanical, Electrical & Information Engineering, Shandong University, Shandong, China.
| | - Yingbin Wang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Shandong, China; The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, Shandong, China
| | - Chao Zhou
- Department of computer science and technology, Tsinghua University, Beijing, China
| | - Wenxiu Geng
- College of Software, Shandong University, Shandong, China
| | - Fan Zhang
- College of Software, Shandong University, Shandong, China
| | - Juan Liu
- College of Software, Shandong University, Shandong, China
| | - Chenglei Yang
- College of Software, Shandong University, Shandong, China.
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Verheggen ICM, de Jong JJA, van Boxtel MPJ, Gronenschild EHBM, Palm WM, Postma AA, Jansen JFA, Verhey FRJ, Backes WH. Increase in blood-brain barrier leakage in healthy, older adults. GeroScience 2020; 42:1183-1193. [PMID: 32601792 PMCID: PMC7394987 DOI: 10.1007/s11357-020-00211-2] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/02/2020] [Indexed: 12/22/2022] Open
Abstract
Blood-brain barrier (BBB) breakdown can disrupt nutrient supply and waste removal, which affects neuronal functioning. Currently, dynamic contrast-enhanced (DCE) MRI is the preferred in-vivo method to quantify BBB leakage. Dedicated DCE MRI studies in normal aging individuals are lacking, which could hamper value estimation and interpretation of leakage rate in pathological conditions. Therefore, we applied DCE MRI to investigate the association between BBB disruption and age in a healthy sample. Fifty-seven cognitively and neurologically healthy, middle-aged to older participants (mean age: 66 years, range: 47-91 years) underwent MRI, including DCE MRI with intravenous injection of a gadolinium-based contrast agent. Pharmacokinetic modeling was applied to contrast concentration time-curves to estimate BBB leakage rate in each voxel. Subsequently, leakage rate was calculated in the white and gray matter, and primary (basic sensory and motor functions), secondary (association areas), and tertiary (higher-order cognition) brain regions. A difference in vulnerability to deterioration was expected between these regions, with especially tertiary regions being affected by age. Higher BBB leakage rate was significantly associated with older age in the white and gray matter, and also in tertiary, but not in primary or secondary brain regions. Even in healthy individuals, BBB disruption was stronger in older persons, which suggests BBB disruption is a normal physiologically aging phenomenon. Age-related increase in BBB disruption occurred especially in brain regions most vulnerable to age-related deterioration, which may indicate that BBB disruption is an underlying mechanism of normal age-related decline.Netherlands Trial Register number: NL6358, date of registration: 2017-03-24.
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Affiliation(s)
- Inge C M Verheggen
- Department of Psychiatry and Neuropsychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
- Alzheimer Center Limburg, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Joost J A de Jong
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Martin P J van Boxtel
- Department of Psychiatry and Neuropsychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Alzheimer Center Limburg, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Ed H B M Gronenschild
- Department of Psychiatry and Neuropsychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Alzheimer Center Limburg, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Walter M Palm
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alida A Postma
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jacobus F A Jansen
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Frans R J Verhey
- Department of Psychiatry and Neuropsychology, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Alzheimer Center Limburg, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Walter H Backes
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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Lüscher TF. Unanswered questions in hypertension: prematurity and long-term trajectories, masked and white coat hypertension. Eur Heart J 2020; 41:1527-1530. [PMID: 33216878 DOI: 10.1093/eurheartj/ehaa275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thomas F Lüscher
- Professor of Cardiology, Imperial College and Director of Research, Education & Development, Royal Brompton and Harefield Hospitals London, UK.,Professor and Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland.,Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, 8032 Zurich, Switzerland
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Abstract
White-coat and masked hypertension are important hypertension phenotypes. Out-of-office blood pressure measurement is essential for the accurate diagnosis and monitoring of these conditions. This review summarizes literature related to the detection and diagnosis, prevalence, epidemiology, prognosis, and treatment of white-coat and masked hypertension. Cardiovascular risk in white-coat hypertension appears to be dependent on the presence of coexisting risk factors, whereas patients with masked hypertension are at increased risk of target organ damage and cardiovascular events. There is an unmet need for robust data to support recommendations around the use of antihypertensive treatment for the management of white-coat and masked hypertension.
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Affiliation(s)
- Kazuomi Kario
- From the Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan (K.K.)
| | - Lutgarde Thijs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.)
| | - Jan A Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.T., J.A.S.).,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands (J.A.S.)
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Lee Y, Park J, Jang MJ, Moon HR, Kim DK, Oh KH, Joo KW, Lim CS, Kim YS, Na KY, Han SS. Development of model to predict end-stage renal disease after coronary artery bypass grafting: The ACHE score. Medicine (Baltimore) 2019; 98:e15789. [PMID: 31124973 PMCID: PMC6571385 DOI: 10.1097/md.0000000000015789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 04/22/2019] [Accepted: 05/02/2019] [Indexed: 01/27/2023] Open
Abstract
Because end-stage renal disease (ESRD) increases the risks of morbidity and mortality, early detection and prevention of ESRD is a critical issue in clinical practice. However, no ESRD-prediction models have been developed or validated in patients undergoing coronary artery bypass grafting (CABG).This is a retrospective multicenter cohort study, recruited between January 2004 and December 2015. A cohort of 3089 patients undergoing CABG in two tertiary referral centers was analyzed to derive a risk-prediction model. The model was developed using Cox proportional hazard analyses, and its performance was assessed using C-statistics. The model was externally validated in an independent cohort of 279 patients.During the median follow-up of 6 years (maximum 13 years), ESRD occurred in 60 patients (2.0%). Through stepwise selection multivariate analyses, the following three variables were finally included in the ESRD-prediction model: postoperative Acute kidney injury, underlying Chronic kidney disease, and the number of antiHypertensive drugs (ACHE score). This model showed good performance in predicting ESRD with the following C-statistics: 0.89 (95% confidence interval [CI] 0.84-0.94) in the development cohort and 0.82 (95% CI 0.60-1.00) in the external validation cohort.The present ESRD-prediction model may be applicable to patients undergoing CABG, with the advantage of simplicity and preciseness.
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Affiliation(s)
- Yeonhee Lee
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Jiwon Park
- Medical Research Collaborating Center, Seoul National University Hospital
| | - Myoung-Jin Jang
- Medical Research Collaborating Center, Seoul National University Hospital
| | - Hong Ran Moon
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine
- Department of Internal Medicine, Boramae Medical Center, Seoul
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Ki Young Na
- Department of Internal Medicine, Seoul National University College of Medicine
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine
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Nagarajan N, Jalal D. Resistant Hypertension: Diagnosis and Management. Adv Chronic Kidney Dis 2019; 26:99-109. [PMID: 31023454 DOI: 10.1053/j.ackd.2019.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/02/2019] [Accepted: 03/04/2019] [Indexed: 12/19/2022]
Abstract
Resistant hypertension is defined as high blood pressure requiring 3 or more medications for adequate control or controlled blood pressure requiring 4 or more medications. Considering the growing prevalence of hypertension and the strong link with cardiovascular disease, it is vital to understand the causes and treatment of resistant hypertension. This review article starts with an overview of the prevalence and little-known pathophysiology of resistant hypertension. Afterward, we discuss the evaluation and management of suspected secondary resistant hypertension in 2 broad categories: pseudoresistant hypertension and true resistant hypertension. Strategies for the identification and management of pseudoresistant hypertension are addressed. In addition, causes of true resistant hypertension, such as obstructive sleep apnea, primary aldosteronism, and renal artery stenosis, are examined along with their respective treatments. Finally, treatment of resistant hypertension is reviewed including pharmacologic treatments and novel procedural interventions for resistant hypertension. Overall, the review hopes to provide practitioners with a cohesive approach for the diagnosis and treatment of resistant hypertension.
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Shahab H, Khan HS, Almas A, Tufail M, Kazmi KA, Khan AH. The Post Clinic Ambulatory Blood Pressure (PC-ABP) study correlates Post Clinic Blood Pressure (PCBP) with the gold standard Ambulatory Blood Pressure. BMC Res Notes 2018; 11:460. [PMID: 29996947 PMCID: PMC6042456 DOI: 10.1186/s13104-018-3509-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/18/2018] [Indexed: 11/10/2022] Open
Abstract
Objective Our previous study showed that post-clinic blood pressure (BP) taken 15 min after a physician–patient encounter was the lowest reading in a routine clinic. We aimed to validate this reading with 24 h Ambulatory Blood Pressure Monitoring (ABPM) readings. A cross-sectional study was conducted in the cardiology clinics at the Aga Khan University, Pakistan. Hypertensive patients aged ≥ 18 years, or those referred for the diagnosis of hypertension were included. Results Of 150 participants, 49% were males. 76% of all participants were hypertensive. Pre-clinic BP reading was measured by a nurse, in-clinic by a physician and 15 min post-clinic by a research assistant using a validated, automated BP device (Omron-HEM7221-E). All patients were referred for 24 h ABPM. Among the three readings taken during a clinic visit, mean (± SD) systolic BP (SBP) pre-clinic, in-clinic, and 15 min post-clinic were 153.2 ± 23, 152.3 ± 21, and 140.0 ± 18 mmHg, respectively. Mean (± SD) diastolic BP (DBP) taken pre-clinic, in-clinic and 15 min post-clinic were 83.5 ± 12, 90.9 ± 12, and 86.4 ± 11 mmHg respectively. Mean (± SD) daytime ambulatory SBP, DBP and pulse readings were 134.7 ± 15, 78.7 ± 15 mmHg, and 72.6 ± 12/min, respectively. Pearson correlation coefficients of pre-clinic, in-clinic and post-clinic SBP with daytime ambulatory-SBP were 0.4 (p value: < 0.001), 0.5 (p value: < 0.001) and 0.6 (p value: < 0.001), respectively. Post-clinic BP has a good correlation with ambulatory BP and may be considered a more reliable reading in the clinic setting.
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Affiliation(s)
- Hunaina Shahab
- Cardiology, Aga Khan University Hospital, Second Floor, Faculty Offices Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Hamza Sohail Khan
- Cardiology, Aga Khan University Hospital, Second Floor, Faculty Offices Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Aysha Almas
- Internal Medicine, Aga Khan University Hospital, Second Floor, Faculty Offices Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Mayera Tufail
- Cardiology, Aga Khan University Hospital, Second Floor, Faculty Offices Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Khawar Abbas Kazmi
- Cardiology, Aga Khan University Hospital, Second Floor, Faculty Offices Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Aamir Hameed Khan
- Cardiology, Aga Khan University Hospital, Second Floor, Faculty Offices Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
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Office white-coat effect tail and long-term cardiovascular risks in the Gubbio residential cohort study. J Hypertens 2018; 36:1825-1832. [PMID: 29846329 DOI: 10.1097/hjh.0000000000001807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE The aim was to investigate whether office white-coat effect tail (OWCET), the waning of blood pressure (BP) after its waxing during office visit, predicted long-term major fatal and nonfatal events in the Gubbio residential cohort. METHODS There were 3572 persons (44% men, 54 ± 11 years old) included. OWCET was defined as a decrease of 10 mmHg or more in SBP between the third and first measurement out of a series obtained a few min apart in which the second and third were considered actual baseline SBP at enrollment. Cardiovascular (CVD), including strokes and coronary heart disease (CHD) hard criteria incidences and deaths along with all-cause deaths were considered. RESULTS Over 185 months median follow-up, individuals with OWCET had significantly higher risk factors except for smoking, which was less frequent. OWCET was associated with an increased risk of both CVD [HR 1.25 (95% CI 1.02-1.52)] and CHD [HR 1.35 (95% CI 1.01-1.80)] events independently of traditional risk factors (age, sex, total cholesterol, HDL, cigarettes and BMI) including SBP. When effective antihypertensive treatment was considered, there was a significant higher CVD risk in individuals with OWCET (P < 0.037). In uncontrolled or untreated individuals, those with OWCET also had a higher risk (P < 0.073). CONCLUSION In primary care, OWCET should be searched for as it can improve stratification of long-term CVD-CHD risks.
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Schlemmer M, Desrichard O. Is Medical Environment Detrimental to Memory? A Test of A White Coat Effect on Older People's Memory Performance. Clin Gerontol 2018; 41:77-81. [PMID: 28406393 DOI: 10.1080/07317115.2017.1307891] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Test if older people's memory assessment may be impacted by a medical environment and if memory self-efficacy (MSE) will moderate this effect. METHODS We evaluated memory performance and MSE in 27 older adults in two different settings: a (control) university research environment, or a (proxy-medical) neuropsychological examination environment. RESULTS The results showed a MSE × environment interaction effect on story-recall performance, with older people with low MSE performing less well in the proxy-medical situation than in the control situation and with elders with high MSE performing better in the proxy-medical situation than in the control situation. The same marginally significant effect for the word-span task was also found. CONCLUSIONS Testing in a medical environment undermines the memory performance of older people with low MSE and boosts performance of older people with high MSE. Clinical Implications We encourage neuropsychologists to pay attention to psychosocial determinants of older people's performance when assessing their memory abilities.
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Could White Coat Ocular Hypertension Affect to the Accuracy of the Diagnosis of Glaucoma? Relationships Between Anxiety and Intraocular Pressure in a Simulated Clinical Setting. Appl Psychophysiol Biofeedback 2017; 43:49-56. [DOI: 10.1007/s10484-017-9385-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Guo S, Lin H, Pan S, Zhai X, Meng L. The differential diagnostic value of serum homocysteine for white coat hypertension. Oncotarget 2017; 8:101271-101283. [PMID: 29254163 PMCID: PMC5731873 DOI: 10.18632/oncotarget.21020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 08/28/2017] [Indexed: 01/31/2023] Open
Abstract
Objective To assess the value of serum homocysteine (Hcy) in differential diagnosis of white coat hypertension (WCH). Results In this retrospective study, serum Hcy levels were elevated in hypertensive patients (P < 0.001) compared to WCH patients. Serum Hcy levels were positively correlated with 24-h mean systolic blood pressure, r = 0.1378, P < 0.001. The results of the receiving operating characteristic (ROC) curve showed that the AUC value of Hcy was 0.80 (95% CI, 0.77–0.83), the cut-off value was 13.8 μmol/L, the sensitivity was 68.58% and the specificity 87.21%. In the prospective study, the AUC value of Hcy was 0.73 (95% CI: 0.67–0.78), higher than N - terminal pro - brain natriuretic peptide(NT-pro-BNP) (0.64, 95% CI:0.58–0.70) and cystatin C (Cys-C) (0.62, 95% CI:0.55–0.68). Hcy, NT-proBNP and Cys-C combined, provided a better indication of a differential diagnosis of WCH, than Hcy alone. Materials and Methods This investigation involved both a retrospective and a prospective study. Clinical data including blood pressure, age, sex, height, weight, BMI, smoking status, past history, and behavioral electrocardiogram of patients who had undergone 24-hour ambulatory blood pressure monitoring (ABPM) with elevated clinical blood pressure (BP) were recorded. Pearson correlation analysis was used to test the correlation between Hcy and BP. The ROC curve was used to analyze the value of measuring Hcy levels in differential diagnosis of WCH. Conclusions Serum Hcy was decreased in WCH patients and therefore could be a biomarker for differential diagnosis of WCH.
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Affiliation(s)
- Shitian Guo
- School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Hui Lin
- Department of Cardiology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, Zhejiang, China.,The First Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Sunlei Pan
- Department of Cardiology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, Zhejiang, China.,The First Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaoya Zhai
- Department of Cardiology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, Zhejiang, China
| | - Liping Meng
- Department of Cardiology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, Zhejiang, China
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The Cardiovascular Risk of White-Coat Hypertension. J Am Coll Cardiol 2017; 68:2033-2043. [PMID: 27810041 DOI: 10.1016/j.jacc.2016.08.035] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/03/2016] [Accepted: 08/09/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND The role of white-coat hypertension (WCH) and the white-coat-effect (WCE) in development of cardiovascular disease (CVD) risk remains poorly understood. OBJECTIVES Using data from the population-based, 11-cohort IDACO (International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes), this study compared daytime ambulatory blood pressure monitoring with conventional blood pressure measurements in 653 untreated subjects with WCH and 653 normotensive control subjects. METHODS European Society Hypertension guidelines were used as a 5-stage risk score. Low risk was defined as 0 to 2 risk factors, and high risk was defined as ≥3 to 5 risk factors, diabetes, and/or history of prior CVD events. Age- and cohort-matching was done between 653 untreated subjects with WCH and 653 normotensive control subjects. RESULTS In a stepwise linear regression model, systolic WCE increased by 3.8 mm Hg (95% confidence interval [CI]: 3.1 to 4.6 mm Hg) per 10-year increase in age, and was similar in low- and high-risk subjects with or without prior CVD events. Over a median 10.6-year follow-up, incidence of new CVD events was higher in 159 high-risk subjects with WCH compared with 159 cohort- and age-matched high-risk normotensive subjects (adjusted hazard ratio [HR]: 2.06; 95% CI: 1.10 to 3.84; p = 0.023). The HR was not significant for 494 participants with low-risk WCH and age-matched low-risk normotensive subjects. Subgroup analysis by age showed that an association between WCH and incident CVD events is limited to older (age ≥60 years) high-risk WCH subjects; the adjusted HR was 2.19 (95% CI: 1.09 to 4.37; p = 0.027) in the older high-risk group and 0.88 (95% CI: 0.51 to 1.53; p = 0.66) in the older low-risk group (p for interaction = 0.044). CONCLUSIONS WCE size is related to aging, not to CVD risk. CVD risk in most persons with WCH is comparable to age- and risk-adjusted normotensive control subjects.
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16
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Lüscher TF. From systemic and pulmonary hypertension to heart failure: novel drugs and devices. Eur Heart J 2017; 38:1087-1090. [DOI: 10.1093/eurheartj/ehx148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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Bloomfield DA, Park A. Decoding white coat hypertension. World J Clin Cases 2017; 5:82-92. [PMID: 28352632 PMCID: PMC5352963 DOI: 10.12998/wjcc.v5.i3.82] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/13/2016] [Accepted: 12/01/2016] [Indexed: 02/05/2023] Open
Abstract
There is arguably no less understood or more intriguing problem in hypertension that the "white coat" condition, the standard concept of which is significantly blood pressure reading obtained by medical personnel of authoritative standing than that obtained by more junior and less authoritative personnel and by the patients themselves. Using hospital-initiated ambulatory blood pressure monitoring, the while effect manifests as initial and ending pressure elevations, and, in treated patients, a low daytime profile. The effect is essentially systolic. Pure diastolic white coat hypertension appears to be exceedingly rare. On the basis of the studies, we believe that the white coat phenomenon is a common, periodic, neuro-endocrine reflex conditioned by anticipation of having the blood pressure taken and the fear of what this measurement may indicate concerning future illness. It does not change with time, or with prolonged association with the physician, particularly with advancing years, it may be superimposed upon essential hypertension, and in patients receiving hypertensive medication, blunting of the nighttime dip, which occurs in about half the patients, may be a compensatory mechanisms, rather than an indication of cardiovascular risk. Rather than the blunted dip, the morning surge or the widened pulse pressure, cardiovascular risk appears to be related to elevation of the average night time pressure.
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Méndez-Ulrich JL, Sanz A. Psycho-ophthalmology: Contributions of Health psychology to the assessment and treatment of glaucoma. Psychol Health 2016; 32:330-342. [PMID: 28004586 DOI: 10.1080/08870446.2016.1268690] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Asymptomatic in its early stages, glaucoma is the second leading cause of blindness worldwide. While psychosocial factors are taken into consideration for a host of diseases such as cancer, heart disease and autoimmune conditions, to date, psychological issues have been ignored in the clinical management of glaucoma. OBJECTIVE This work reviews the most relevant contributions from a health psychology perspective for the assessment and treatment of glaucoma, which is emerging in the field of psycho-ophthalmology. METHOD To provide scientific evidence regarding contributions of psychology to the comprehension of glaucoma, a bibliographic review of three databases (Psicodoc, PsycInfo and Medline) was conducted, spanning the period between 1940 and 2016. RESULTS This review yielded a total of 66 studies published in the period analysed and identified three areas where health psychology has made substantive contributions to glaucoma screening, monitoring and treatment: the emotional impact on patients suffering from glaucoma, the adherence to treatment and the effects of stress on intraocular pressure. CONCLUSIONS A health psychology approach for research and therapy of glaucoma must focus on the management of the negative affect associated with the diagnosis, the optimisation of treatment adherence and the stress management of the intraocular pressure measurements.
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Affiliation(s)
- Jorge Luis Méndez-Ulrich
- a Faculty of Psychology, Research Group on Stress and Health, Department of Basic, Developmental and Educational Psychology , Universitat Autònoma de Barcelona , Catalonia , Spain
| | - Antoni Sanz
- a Faculty of Psychology, Research Group on Stress and Health, Department of Basic, Developmental and Educational Psychology , Universitat Autònoma de Barcelona , Catalonia , Spain
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Martin U, Haque MS, Wood S, Greenfield SM, Gill PS, Mant J, Mohammed MA, Heer G, Johal A, Kaur R, Schwartz C, McManus RJ. Ethnicity and differences between clinic and ambulatory blood pressure measurements. Am J Hypertens 2015; 28:729-38. [PMID: 25398890 DOI: 10.1093/ajh/hpu211] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/04/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND This study investigated the relationship of ethnicity to the differences between blood pressure (BP) measured in a clinic setting and by ambulatory blood pressure monitoring (ABPM) in individuals with a previous diagnosis of hypertension (HT) and without a previous diagnosis of hypertension (NHT). METHODS A cross-sectional comparison of BP measurement was performed in 770 participants (white British (WB, 39%), South Asian (SA, 31%), and African Caribbean (AC, 30%)) in 28 primary care clinics in West Midlands, United Kingdom. Mean differences between daytime ABPM, standardized clinic (mean of 3 occasions), casual clinic (first reading on first occasion), and last routine BP taken at the general practitioner practice were compared in HT and NHT individuals. RESULTS Daytime systolic and diastolic ABPM readings were similar to standardized clinic BP (systolic: 128 (SE 0.9) vs. 125 (SE 0.9) mm Hg (NHT) and 132 (SE 0.7) vs. 131 (SE 0.7) mm Hg (HT)) and were not associated with ethnicity to a clinically important extent. When BP was taken less carefully, differences emerged: casual clinic readings were higher than ABPM, particularly in the HT group where the systolic differences approached clinical relevance (131 (SE 1.2) vs. 129 (SE 1.0) mm Hg (NHT) and 139 (SE 0.9) vs. 133 (SE 0.7) mm Hg (HT)) and were larger in SA and AC hypertensive individuals (136 (SE 1.5) vs. 133 (SE 1.2) mm Hg (WB), 141 (SE 1.7) vs. 133 (SE 1.4) mm Hg (SA), and 142 (SE 1.6) vs. 134 (SE 1.3) mm Hg (AC); mean differences: 3 (0-7), P = 0.03 and 4 (1-7), P = 0.01, respectively). Differences were also observed for the last practice reading in SA and ACs. CONCLUSIONS BP differences between ethnic groups where BP is carefully measured on multiple occasions are small and unlikely to alter clinical management. When BP is measured casually on a single occasion or in routine care, differences appear that could approach clinical relevance.
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Affiliation(s)
- Una Martin
- Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK;
| | - M Sayeed Haque
- Primary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Sally Wood
- Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - Sheila M Greenfield
- Primary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Paramjit S Gill
- Primary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Jonathan Mant
- Primary Care Unit, University of Cambridge, Cambridge, UK
| | | | - Gurdip Heer
- Primary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Amanpreet Johal
- Primary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Ramendeep Kaur
- Primary Care Clinical Sciences, NIHR School for Primary Care Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Claire Schwartz
- Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
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Younge J, Wester V, van Rossum E, Gotink R, Wery M, Utens E, Hunink M, Roos-Hesselink J. Cortisol levels in scalp hair of patients with structural heart disease. Int J Cardiol 2015; 184:71-78. [DOI: 10.1016/j.ijcard.2015.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 01/20/2015] [Accepted: 02/07/2015] [Indexed: 01/15/2023]
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Stability of daily home-based measures of postural control over an 8-week period in highly functioning older adults. Eur J Appl Physiol 2014; 115:437-49. [PMID: 25344800 DOI: 10.1007/s00421-014-3034-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 10/16/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The focus of this study was to monitor daily objective measures of standing postural control over an 8-week period, recorded in a person's home, in a population of healthy older adults. Establishing natural patterns of variation in the day-to-day signal, occurring in the relative absence of functional decline or disease, would enable us to determine thresholds for changes in postural control from baseline that could be considered clinically important. METHODS Eighteen community-dwelling older adults (3 M, 15 F, 72 ± 6 years) participated in a home-based trial where each day they were asked to complete a technology-enabled routine consisting of a short questionnaire, as well as a quiet standing balance trial. Centre of pressure (COP) excursions were calculated over the course of each daily balance trial to generate variables such as postural sway length and mean sway frequency. RESULTS The data demonstrated large differences between subjects in centre of pressure measures (coefficients of variation ranging 37-107 %, depending on the variable). Each participant also exhibited variations in their day-to-day trials (e.g. coefficients of variation across 8 weeks ranging ~17-56 %, within person for mean COP distance). Inter- and intra-subject differences were not strongly related to functional tests, suggesting that these variations were not necessarily aberrant movement patterns, but are seemingly representative of natural movement variability. CONCLUSIONS The idea of applying a group-focused approach at an individual level may result in misclassifying important changes for a particular individual. Early detection of deterioration can only be achieved through the creation of individual trajectories for each person, that are inherently self referential.
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Suzuki H, Kobayashi K, Okada H. Combination of Echocardiography and Pulse Wave Velocity Provides Clues for the Differentiation between White Coat Hypertension and Hypertension in Postmenopausal Women. Pulse (Basel) 2014; 1:131-8. [PMID: 26587432 PMCID: PMC4315353 DOI: 10.1159/000360977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To determine whether or not noninvasive assessment of the cardiovascular system can discriminate white coat hypertension and hypertension in postmenopausal women. The major reason is the high prevalence of white coat hypertension in these subjects and the uncertain associations of white coat hypertension with cardiovascular risk. PATIENTS AND METHODS Selected women were required to be naturally or surgically menopausal for at least 1 year but not more than 5 years past their menstrual period. White coat hypertension patients were defined as subjects who had office blood pressures >150/90 mm Hg but who had both systolic and diastolic ambulatory pressures <120/80 mm Hg. In total, 44 subjects with a mean age of 52 years were recruited from the outpatient clinic and examined. Office and home blood pressures were measured using the HEM 401C (Omron Life Science Co. Ltd., Tokyo, Japan), a semi-automatic device that operates on the cuff-oscillometric principle and generates a digital display of the systolic (SBP) and diastolic blood pressure as well as the pulse rate. The pulse wave velocity (PWV) was recorded, and the left ventricular (LV) diameter, septal wall thickness, and left posterior wall thickness were assessed by M-mode echocardiography after selecting the measurement section by B-mode echocardiography. RESULTS Twenty patients were diagnosed as having white coat hypertension based on the criteria in the trial. Pulse wave patterns were different between subjects with white coat hypertension and those with hypertension. PWV of subjects with white coat hypertension was 1.32 ± 0.33 m/s and that of patients with hypertension was 1.46 ± 0.37 m/s (p < 0.01). In addition to these findings, there was a significant association between the values of home SBP and PWV and the LV mass index. However, this association was not seen for office SBP. When the data of the LV mass index and PWV were combined, white coat hypertension could be easily differentiated from hypertension. CONCLUSIONS The combination of blood pressure self-monitoring, echocardiographic data, and PWV can be a powerful indicator for the treatment of hypertension in postmenopausal women.
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Affiliation(s)
- Hiromichi Suzuki
- Department of Internal Medicine, Ikebukuro Hospital, Saitama, Japan ; Department of Nephrology, Saitama Medical School, Saitama, Japan
| | | | - Hirokazu Okada
- Department of Nephrology, Saitama Medical School, Saitama, Japan
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Significance of white-coat and masked hypertension in chronic kidney disease and end-stage renal disease. Hypertens Res 2014; 37:882-9. [PMID: 24739541 DOI: 10.1038/hr.2014.82] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/17/2014] [Accepted: 02/18/2014] [Indexed: 11/08/2022]
Abstract
Hypertension is a frequent and modifiable cardiovascular risk factor with a cyclic relationship with chronic kidney disease (CKD). The diagnosis, treatment, monitoring and control of high blood pressure are all mandatory not only in CKD but also in end-stage renal disease (ESRD). As demonstrated by studies using population and hypertensive patients, white-coat hypertension (WCHT) and masked hypertension (MHT) carry a particular degree of risk. The advantages of ambulatory techniques in the management and prognostic stratification of patients with CKD and ESRD have also been recognized. However, most of the evidence underlines the importance of nocturnal hypertension and neglects WCHT and MHT. The absence of specific reports involving untreated and treated patients hinders the ability to significantly discriminate WCHT from the white-coat effect and MHT from masked uncontrolled hypertension. The heterogeneous definitions that are used add additional difficulty in translating experimental evidence into clinical practice. Reaching a consensus in definitions is mandatory for designing future research. Cross-sectional studies underscore the frequency of misdiagnosis, potentially leading to undertreatment (MHT) and overtreatment (WCHT) in renal disease. The divergent prevalence of WCHT and MHT reported in CKD could be related to the diverse definitions of hypertension and the heterogeneity of the pathologies pooled under the CKD definition. Even in the absence of randomized clinical trials specifically addressing this issue, the scarce longitudinal studies confirm that WCHT carries a risk close to that of sustained normotension, whereas MHT is associated with a risk close or identical to that of sustained hypertension.
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Volpe M, Tocci G. Challenging hypertension: how to diagnose and treat resistant hypertension in daily clinical practice. Expert Rev Cardiovasc Ther 2014; 8:811-20. [DOI: 10.1586/erc.10.47] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Affiliation(s)
- Stanley S. Franklin
- From the Heart Disease Prevention Program, Division of Cardiology, School of Medicine, University of California, Irvine (S.S.F.); Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., J.A.S.); Steno Diabetes Center, Gentofte, Denmark (T.W.H.); and Conway Institute, University College Dublin, Dublin, Ireland (E.O.)
| | - Lutgarde Thijs
- From the Heart Disease Prevention Program, Division of Cardiology, School of Medicine, University of California, Irvine (S.S.F.); Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., J.A.S.); Steno Diabetes Center, Gentofte, Denmark (T.W.H.); and Conway Institute, University College Dublin, Dublin, Ireland (E.O.)
| | - Tine W. Hansen
- From the Heart Disease Prevention Program, Division of Cardiology, School of Medicine, University of California, Irvine (S.S.F.); Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., J.A.S.); Steno Diabetes Center, Gentofte, Denmark (T.W.H.); and Conway Institute, University College Dublin, Dublin, Ireland (E.O.)
| | - Eoin O’Brien
- From the Heart Disease Prevention Program, Division of Cardiology, School of Medicine, University of California, Irvine (S.S.F.); Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., J.A.S.); Steno Diabetes Center, Gentofte, Denmark (T.W.H.); and Conway Institute, University College Dublin, Dublin, Ireland (E.O.)
| | - Jan A. Staessen
- From the Heart Disease Prevention Program, Division of Cardiology, School of Medicine, University of California, Irvine (S.S.F.); Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (L.T., J.A.S.); Steno Diabetes Center, Gentofte, Denmark (T.W.H.); and Conway Institute, University College Dublin, Dublin, Ireland (E.O.)
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Depressed mood and blood pressure: The moderating effect of situation-specific arousal levels. Int J Psychophysiol 2012; 85:212-23. [DOI: 10.1016/j.ijpsycho.2012.04.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 04/20/2012] [Accepted: 04/24/2012] [Indexed: 01/30/2023]
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Franklin SS, Thijs L, Staessen JA. Does Pseudoresistant Hypertension Attributed to White-Coat Effect Define Subjects With “Treated Normalized Hypertension?”. Hypertension 2012; 59:e43; author reply e44. [DOI: 10.1161/hypertensionaha.112.192781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stanley S. Franklin
- Heart Disease Prevention Program Division of Cardiology, School of Medicine University of California Irvine, CA (Franklin)
| | - Lutgarde Thijs
- Studies Coordinating Centre Division of Hypertension and Cardiovascular Rehabilitation Department of Cardiovascular Sciences University of Leuven Leuven, Belgium (Thijs)
| | - Jan A. Staessen
- Studies Coordinating Centre Division of Hypertension and Cardiovascular Rehabilitation Department of Cardiovascular Sciences University of Leuven Leuven, Belgium Department of Epidemiology Maastricht University Maastricht, The Netherlands (Staessen)
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Franklin SS, Thijs L, Hansen TW, Li Y, Boggia J, Kikuya M, Björklund-Bodegård K, Ohkubo T, Jeppesen J, Torp-Pedersen C, Dolan E, Kuznetsova T, Stolarz-Skrzypek K, Tikhonoff V, Malyutina S, Casiglia E, Nikitin Y, Lind L, Sandoya E, Kawecka-Jaszcz K, Imai Y, Wang J, Ibsen H, O'Brien E, Staessen JA. 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. Hypertension 2012; 59:564-71. [PMID: 22252396 DOI: 10.1161/hypertensionaha.111.180653] [Citation(s) in RCA: 144] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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.
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Affiliation(s)
- Stanley S Franklin
- Heart Disease Prevention Program, Division of Cardiology, School of Medicine, University of California, Irvine, CA, USA
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O’Brien E. Why ABPM Should Be Mandatory in All Trials of Blood Pressure-Lowering Drugs. ACTA ACUST UNITED AC 2011. [DOI: 10.1177/009286151104500303] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Aekplakorn W. Prevalence, treatment, and control of metabolic risk factors by BMI status in Thai adults: National Health Examination Survey III. Asia Pac J Public Health 2010; 23:298-306. [PMID: 20460284 DOI: 10.1177/1010539509340690] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to determine the prevalence, awareness, treatment, and control of hypertension, diabetes, and high total cholesterol (TC) by BMI categories. Data from the National Health Examination Survey III of Thai adults aged≥18 years were used. Age and sex-adjusted prevalence and awareness of the 3 risk factors increased with increases in BMI categories. Proportions of awareness of hypertension, diabetes, and high TC were 27.9%, 33.4%, and 13.6%, respectively, in the BMI≥30 kg/m2 group. The highest treatment rates of 19.0% for hypertension and 10.1% for high TC were found in the BMI≥30 kg/m2 group and the highest treatment rate of 33.6% for diabetes in the 25 to 30 kg/m2 BMI group. There were no significant differences in the control rates of these risk factors across BMI groups. Improvement in detection, treatment, and control of these metabolic risk factors in all BMI subgroups is critical.
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Affiliation(s)
- Wichai Aekplakorn
- Community Medicine Center, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Mallick S, Kanthety R, Rahman M. Home blood pressure monitoring in clinical practice: a review. Am J Med 2009; 122:803-10. [PMID: 19699371 DOI: 10.1016/j.amjmed.2009.02.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 02/09/2009] [Accepted: 02/11/2009] [Indexed: 11/29/2022]
Abstract
Home blood pressure monitoring is a convenient and inexpensive technique to monitor blood pressure in hypertensive patients. There are convincing data that home blood pressure monitoring is a good predictor of future cardiovascular risk, perhaps better than office blood pressure. Home blood pressure measurement can be standardized using validated instruments and systematic protocols; normative criteria have established home blood pressure >135/85 mm Hg as hypertensive. Home blood pressure monitoring has been shown to improve compliance and blood pressure control, and to reduce health care costs. Ongoing studies are evaluating management of hypertension based on home blood pressure readings compared with traditional office-based readings. Home blood pressure monitoring is particularly useful for evaluation of white coat hypertension and masked hypertension. In this article, we discuss the methodology for measuring blood pressure at home, its comparison to the other measurement techniques, the advantages and disadvantages, cost benefit analyses, and ongoing clinical trials to help define the role of home blood pressure monitoring in the clinical management of hypertension.
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Affiliation(s)
- Salman Mallick
- Department of Medicine, St. Vincent's Charity Hospital, Cleveland, Ohio, USA
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Tomlinson LA, Holt SG, Leslie AR, Rajkumar C. Prevalence of ambulatory hypotension in elderly patients with CKD stages 3 and 4. Nephrol Dial Transplant 2009; 24:3751-5. [DOI: 10.1093/ndt/gfp357] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Grandi AM, Solbiati F, Laurita E, Cassinerio E, Marchesi C, Piperno F, Maresca A, Guasti L, Venco A. Isolated office hypertension: A 3‐year follow‐up study. Blood Press 2009; 14:298-305. [PMID: 16257876 DOI: 10.1080/08037050500331496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The study aimed to evaluate, over a 3-year period, the progression towards sustained hypertension and left ventricular (LV) changes in patients with isolated office (IO) hypertension (office BP>140 and/or 90 mmHg, daytime BP<130/80 mmHg). After 3 years from the basal evaluation, 38 subjects with basal normal BP and 42 subjects with basal IO hypertension underwent a second 24-h BP monitoring and echocardiography; 19 patients of the basal IO hypertension group were not revaluated because they had already developed ambulatory hypertension and were on antihypertensive treatment. At the second evaluation, the 38 normotensive subjects had unchanged BP and LV parameters; 25 IO hypertensives have developed sustained hypertension. Considering them together with the 19 patients already treated, 72% of 61 IO hypertensives developed ambulatory hypertension over a 3-year period. The patients who subsequently developed hypertension differed from the group who did not only for lower basal values of LV diastolic parameters; all the patients with basal LV hypertrophy and/or preclinical diastolic impairment subsequently developed sustained hypertension. In conclusion, IO hypertensive patients show a high rate of progression towards sustained hypertension. Basal LV hypertrophy and/or preclinical diastolic dysfunction were the only markers of a greater risk of becoming hypertensives.
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Affiliation(s)
- Anna M Grandi
- Department of Clinical Medicine, University of Insubria, Varese, Italy.
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Detection of silent cerebrovascular lesions in individuals with ‘masked’ and ‘white-coat’ hypertension by home blood pressure measurement: the Ohasama study. J Hypertens 2009; 27:1049-55. [DOI: 10.1097/hjh.0b013e3283298522] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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The association between masked hypertension and waist circumference as an obesity-related anthropometric index for metabolic syndrome: the Ohasama study. Hypertens Res 2009; 32:438-43. [DOI: 10.1038/hr.2009.37] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Prevalence and management of prehypertension and hypertension by geographic regions of Thailand: the Third National Health Examination Survey, 2004. J Hypertens 2008; 26:191-8. [PMID: 18192831 DOI: 10.1097/hjh.0b013e3282f09f57] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine the prevalence of prehypertension and hypertension, and management of hypertension, by geographic regions of Thailand. METHODS Using a stratified, multistage sampling design, data from a nationally representative sample of 39 290 individuals aged > or = 15 years were collected by interview, physical examination and blood sample. RESULTS The prevalence of hypertension and prehypertension weighted to the national 2004 population was 22.0% [95% confidence interval (CI) = 20.5-23.6] and 32.8% (95% CI = 31.5-34.1), respectively, with a higher prevalence in men compared to women. Hypertension was more common in urban compared to rural men, but similar between urban and rural women. Despite some variation, the prevalence of hypertension and prehypertension was relatively uniform across geographical regions. Of those identified as having hypertension in the survey, 69.8% (95% CI = 67.8-71.7) were unaware that they had hypertension. Although the majority of those who were aware (78.2%; 95% CI = 75.8-80.5) had taken blood pressure-lowering drugs in the last 2 weeks, of these only 36.6% (95% CI = 33.3-40.0) had blood pressure < 140/90 mmHg. Rural populations and those from the economically poorer Northeast region were more likely to be unaware that they had hypertension. CONCLUSION Compared to previous surveys, the prevalence of hypertension and prehypertension is rising rapidly, and is spread relatively evenly across regions of Thailand. Levels of awareness of hypertension were low across the country. A challenging task remains in improving screening, treatment and control of hypertension at the same time as promoting healthier lifestyles.
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Helvaci MR, Kaya H, Yalcin A, Kuvandik G. Prevalence of white coat hypertension in underweight and overweight subjects. Int Heart J 2008; 48:605-13. [PMID: 17998770 DOI: 10.1536/ihj.48.605] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of the present study was to determine if there is any association between white coat hypertension (WCH) and body mass index. The study was performed in two phases. In the first phase, we studied consecutive underweight patients, while in the second phase, age-matched consecutive normal weight, overweight, and obese cases were studied. Although we detected 61 cases in the underweight group with a mean age of 24.1 years, we could only detect 12 age-matched cases in the obesity group, and thus the obesity group was not used for comparison. When we looked at the prevalences of sustained normotension (NT), WCH, and HT in the groups, there were gradual and significant increases in the prevalences of WCH in addition to the gradual and significant decreases in the sustained NT from the underweight towards the normal weight and overweight groups. Eventually, only 31.5% of the overweight group had sustained NT, even though the mean age of the cases was very young. Due to the gradually increased prevalence of WCH from the underweight towards the normal weight and overweight groups, parallel to the already known increasing prevalences of HT, type 2 diabetes mellitus, hyperbetalipoproteinemia, dyslipidemia, and coronary heart disease and the very low prevalence of sustained NT among the overweight cases even in the early decades here, WCH should preferentially be accepted as an alarming sign of excess weight and many associated disorders in the future, rather than just being considered a predisposing factor of HT or atherosclerosis alone.
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Pierdomenico SD, Lapenna D, Di Mascio R, Cuccurullo F. Short- and long-term risk of cardiovascular events in white-coat hypertension. J Hum Hypertens 2008; 22:408-14. [PMID: 18288127 DOI: 10.1038/jhh.2008.6] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The prognostic impact of white-coat hypertension is not yet completely clear. In this study, we investigated cardiovascular outcome in sustained hypertension, white-coat hypertension and normotension in the short and long term. The occurrence of fatal and nonfatal cardiovascular events was evaluated in 1732 subjects with clinical hypertension (1333 with sustained and 399 with white-coat hypertension) and 305 with normotension. White-coat hypertension was defined as clinical hypertension and daytime blood pressure <135/85 mm Hg. During the period of observation (mean 6.4 years, range 0.7-13.1), 152 cardiovascular events occurred. The event rate per 100 patient-years in subjects with normotension, white-coat and sustained hypertension was 0.38, 0.44 and 1.58, respectively. Event-free survival was significantly different among the groups (P<0.0001). After adjustment for several covariates, Cox regression analysis showed that cardiovascular risk was significantly higher in patients with sustained than in those with white-coat hypertension (relative risk (RR) 3.32, 95% confidence interval (CI) 1.81-6.12, P=0.0001), whereas there was no significant difference between normotension and white-coat hypertension. When events were analysed separately, cardiac and cerebrovascular risk were significantly higher in sustained than in white-coat hypertension (RR 4.16, 95% CI 1.48-11.6, P=0.007, and RR 4.12, 95% CI 1.62-10.5, P=0.003, respectively) and not significantly different between white-coat hypertension and normotension. Event-free survival had the same trend for the whole period of observation both when cardiovascular events were examined together and when cardiac and cerebrovascular events were analysed separately. In this study, cardiovascular risk in white-coat hypertension was significantly lower than that in sustained hypertension and not significantly different from normotension both in the short and long term.
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Affiliation(s)
- S D Pierdomenico
- Department of Medicine and Aging Science, University Gabriele d'Annunzio, Chieti, Italy.
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Helvaci MR, Sevinc A, Camci C, Yalcin A. Treatment of White Coat Hypertension With Metformin. Int Heart J 2008; 49:671-9. [DOI: 10.1536/ihj.49.671] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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TERAWAKI H, METOKI H, NAKAYAMA M, OHKUBO T, KIKUYA M, ASAYAMA K, INOUE R, HOSHI H, ITO S, IMAI Y. Masked Hypertension Determined by Self-Measured Blood Pressure at Home and Chronic Kidney Disease in the Japanese General Population: The Ohasama Study. Hypertens Res 2008; 31:2129-35. [DOI: 10.1291/hypres.31.2129] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Essential hypertension can be defined as a rise in blood pressure of unknown cause that increases risk for cerebral, cardiac, and renal events. In industrialised countries, the risk of becoming hypertensive (blood pressure >140/90 mm Hg) during a lifetime exceeds 90%. Essential hypertension usually clusters with other cardiovascular risk factors such as ageing, being overweight, insulin resistance, diabetes, and hyperlipidaemia. Subtle target-organ damage such as left-ventricular hypertrophy, microalbuminuria, and cognitive dysfunction takes place early in the course of hypertensive cardiovascular disease, although catastrophic events such as stroke, heart attack, renal failure, and dementia usually happen after long periods of uncontrolled hypertension only. All antihypertensive drugs lower blood pressure (by definition) and this decline is the best determinant of cardiovascular risk reduction. However, differences between drugs exist with respect to reduction of target-organ disease and prevention of major cardiovascular events. Most hypertensive patients need two or more drugs for blood-pressure control and concomitant statin treatment for risk factor reduction. Despite the availability of effective and safe antihypertensive drugs, hypertension and its concomitant risk factors remain uncontrolled in most patients.
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Affiliation(s)
- Franz H Messerli
- Division of Cardiology, St Luke's-Roosevelt Hospital Center, Columbia University, College of Physicians and Surgeons, New York, NY 10019, USA.
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Hara A, Ohkubo T, Kikuya M, Shintani Y, Obara T, Metoki H, Inoue R, Asayama K, Hashimoto T, Harasawa T, Aono Y, Otani H, Tanaka K, Hashimoto J, Totsune K, Hoshi H, Satoh H, Imai Y. Detection of carotid atherosclerosis in individuals with masked hypertension and white-coat hypertension by self-measured blood pressure at home: The Ohasama Study. J Hypertens 2007; 25:321-7. [PMID: 17211239 DOI: 10.1097/hjh.0b013e3280115bbf] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate carotid atherosclerosis in individuals with masked hypertension (MHT) and white-coat hypertension (WCHT) in a general population. METHODS Self-measurement of blood pressure at home (HBP) and casual blood pressure (CBP) measurements were recorded in 812 individuals aged at least 55 years (mean 66.4 years) from the general Japanese population. The intima-media thickness (IMT) of the near and far wall of both common carotid arteries was measured and averaged. The relationships between carotid atherosclerosis (IMT and plaque) and the four blood pressure groups (sustained normal blood pressure: HBP < 135/85 mmHg, CBP < 140/90 mmHg; WCHT: HBP < 135/85 mmHg, CBP >or= 140/90 mmHg; MHT: HBP >or= 135/85 mmHg, CBP < 140/90 mmHg; sustained hypertension: HBP >or= 135/85 mmHg, CBP >or= 140/90 mmHg) were examined using multivariate analysis adjusted for possible confounding factors. RESULTS Adjusted IMT in individuals with sustained hypertension [0.77 mm; 95% confidence interval (CI) 0.75 to 0.79 mm] and MHT (0.77 mm; 95% CI 0.73 to 0.80 mm) was significantly greater than in those with sustained normal blood pressure (0.71 mm; 95% CI 0.69 to 0.72 mm) and WCHT (0.72 mm; 95% CI 0.71 to 0.74 mm) (P < 0.0001). The odds ratios for the presence of plaques in all four groups were similar to the trends in IMT. CONCLUSIONS Our findings imply that CBP measurements alone are insufficient to distinguish individuals at high risk of carotid atherosclerosis from those at low risk. However, these individuals do have distinct HBP measurements, suggesting that HBP measurement could become a valuable tool for predicting carotid atherosclerosis.
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Affiliation(s)
- Azusa Hara
- Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai, Japan
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Conen D, Dieterle T, Utech K, Rimner M, Martina B. C-Reactive Protein and B-Type Natriuretic Peptides in Never-Treated White Coat Hypertensives. Hypertens Res 2006; 29:411-5. [PMID: 16940703 DOI: 10.1291/hypres.29.411] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Arterial hypertension has been associated with increased plasma concentrations of C-reactive protein (CRP) and B-type natriuretic peptide (BNP). This study tested the hypothesis that patients with white coat hypertension have lower plasma CRP and BNP concentrations than those with sustained hypertension. A total of 109 consecutive medical outpatients with never-treated office hypertension underwent ambulatory blood pressure monitoring and blood sampling to determine CRP and BNP concentrations. Patients with treated hypertension, lipid-lowering therapy, renal insufficiency or structural heart disease other than left ventricular hypertrophy were excluded. White coat hypertension was defined as office hypertension associated with mean daytime blood pressure values below 135/85 mmHg. A control group of 48 consecutive, age- and sex-matched patients without office hypertension were recruited during the same period. Twenty-six patients (24%) had white coat hypertension. There were no statistically significant differences in baseline variables between patients with sustained hypertension and white coat hypertensives, except for mean blood pressure values. Mean CRP was 3.2+/-5.1 mg/l in patients with white coat hypertension compared to 3.4+/-4.2 mg/l in those with sustained hypertension (p=0.79). Control patients had significantly lower CRP values than patients with either white coat or sustained hypertension (1.2+/-0.9 mg/l, p=0.002 and p=0.038, respectively). Mean BNP concentrations were 21+/-25 pg/l and 44+/-125 pg/l in white coat and sustained hypertensives, respectively (p=0.36). The plasma concentrations of CRP and BNP did not differ between patients with white coat hypertension and those with sustained hypertension.
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Affiliation(s)
- David Conen
- Medical Outpatient Clinic, University Hospital Basel, Basel, Switzerland.
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White WB. Expanding the Use of Ambulatory Blood Pressure Monitoring for the Diagnosis and Management of Patients With Hypertension. Hypertension 2006; 47:14-5. [PMID: 16344365 DOI: 10.1161/01.hyp.0000197184.41588.78] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Redon J. Antihypertensive treatment: should it be titrated to blood pressure reduction or to target organ damage regression? Curr Opin Nephrol Hypertens 2005; 14:448-52. [PMID: 16046903 DOI: 10.1097/01.mnh.0000168935.95527.0a] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The success of an antihypertensive treatment is difficult to estimate by the extent of blood pressure reduction alone. Above and beyond blood pressure values in an individual patient, it is necessary to monitor the impact of antihypertensive treatment on the development or regression of hypertension-induced early end-organ damage. The intermediate objectives or surrogate endpoints may provide additional valuable information about the level of success of a given therapy in a particular patient. Moreover, monitoring intermediate objectives may provide scientific evidence for delineating the best antihypertensive treatment. RECENT FINDINGS The importance of assessing left ventricular mass, microalbuminuria, carotid wall thickness and the development of new-onset diabetes during antihypertensive treatment has been stressed. Left ventricular hypertrophy during antihypertensive therapy is associated with a lower likelihood of cardiovascular morbidity and mortality, independent of blood pressure lowering and treatment modalities in people with essential hypertension. Likewise, a reduction in urinary albumin excretion seems to be followed by a reduction in cardiovascular morbidity and mortality. Risk implications of reducing carotid wall thickness or of developing new-onset diabetes have been more controversial, although it seems to be that both can have a desirable effect. SUMMARY The available findings support the necessity to monitor intermediate objectives, aside from blood pressure measurement, during the follow-up of hypertensives.
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Affiliation(s)
- Josep Redon
- Hypertension Clinic, Hospital Clinico, University of Valencia, Avda Blasco Ibañez 17, 46010 Valencia, Spain.
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Ohkubo T, Kikuya M, Metoki H, Asayama K, Obara T, Hashimoto J, Totsune K, Hoshi H, Satoh H, Imai Y. Prognosis of "masked" hypertension and "white-coat" hypertension detected by 24-h ambulatory blood pressure monitoring 10-year follow-up from the Ohasama study. J Am Coll Cardiol 2005; 46:508-15. [PMID: 16053966 DOI: 10.1016/j.jacc.2005.03.070] [Citation(s) in RCA: 432] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2004] [Revised: 02/23/2005] [Accepted: 03/01/2005] [Indexed: 11/20/2022]
Abstract
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 <135/85 mm Hg; relative hazards [RH])1.28; 95% confidence interval [CI] 0.76 to 2.14) was no different from risk for subjects with sustained normal BP (casual BP <140/90 mm Hg, daytime BP <135/85 mm Hg). However, risk was significantly higher for subjects with MHT (casual BP <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.
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Affiliation(s)
- Takayoshi Ohkubo
- Department of Planning for Drug Development and Clinical Evaluation, Sendai, Japan.
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48
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Verdecchia P, Angeli F. How Can We Use the Results of Ambulatory Blood Pressure Monitoring in Clinical Practice? Hypertension 2005; 46:25-6. [PMID: 15928027 DOI: 10.1161/01.hyp.0000170139.90918.50] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Celis H, Fagard RH. White-coat hypertension: a clinical review. Eur J Intern Med 2004; 15:348-357. [PMID: 15522568 DOI: 10.1016/j.ejim.2004.08.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2004] [Revised: 07/15/2004] [Accepted: 08/02/2004] [Indexed: 10/26/2022]
Abstract
White-coat hypertension (WCHT), also called 'isolated office or clinic hypertension', is defined as the occurrence of blood pressure (BP) values higher than normal when measured in the medical environment, but within the normal range during daily life, usually defined as average daytime ambulatory BP (ABP) or home BP values (<135 mm Hg systolic and <85 mm Hg diastolic). The prevalence of WCHT varies from 15% to over 50% of all patients with mildly elevated office BP (OBP) values. In untreated hypertensive patients, the probability of WCHT especially increases with female gender and a mildly elevated OBP level. The value of other possible determinants such as (non) smoking status, duration of hypertension, left ventricular mass, number of OBP measurements, educational level, etc. is less consistently shown. Although, for various reasons, studies evaluating the long-term effects of WCHT are not always easy to interpret, most data indicate that persons with WCHT have a worse or equal cardiovascular prognosis than normotensives, but a better one than those with sustained hypertension. WCHT is sometimes considered a prehypertensive state, but data on the long-term evolution of subjects with WCHT are scarce. Patients with WCHT and a high cardiovascular risk or proven target organ damage should be pharmacologically treated. Subjects with uncomplicated WCHT should probably not receive medical therapy, but a close follow-up, including regular assessment of other risk factors and measurement of OBP (every 6 months) and ABP (every 1 or 2 years), is warranted.
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Affiliation(s)
- Hilde Celis
- Hypertension and Cardiovascular Rehabilitation Unit, Department of Molecular and Cardiovascular Research, University of Leuven, U.Z. Gasthuisberg–Dienst Hypertensie, Herestraat 49, 3000 Leuven, Belgium
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Gustavsen PH, Høegholm A, Bang LE, Kristensen KS. White coat hypertension is a cardiovascular risk factor: a 10-year follow-up study. J Hum Hypertens 2004; 17:811-7. [PMID: 14704724 DOI: 10.1038/sj.jhh.1001643] [Citation(s) in RCA: 145] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The objective of this paper was to evaluate the cardiovascular risk in white coat hypertension (WCH). WCH is a well-known clinical entity defined by persistently elevated blood pressure (BP) in the doctor's office, whereas BP in other conditions is normal. The prognosis of WCH is unsettled, although two prospective studies that include normal control groups imply that the condition is benign. This study is a 10-year follow-up study on 420 patients with grade I-II hypertension newly diagnosed by their general practitioner and 146 normal controls (NTs). Ambulatory blood pressure (ABP) monitoring was performed at baseline. With our protocollated cutoff value of daytime-ABP <135/90 mmHg, 76 (18.1%) of the 420 hypertensives were white coat hypertensives (WCHs) and 344 were established hypertensives (EHs). With a lower cutoff of 135/85 mmHg, 40 (9.5%) were WCHs. Complete follow-up data were obtained for all 566 subjects. The mean duration of follow-up was 10.2 years (range 9.0-12.5). In the WCH group, 14 first events were recorded (18.4%) consisting of two cardiovascular deaths and 12 nonfatal cardiovascular events. In the EH group, the corresponding number of events were 56 first events (16.3%), 12 cardiovascular deaths and 44 nonfatal cardiovascular events, and in the NT group 10 first events (6.8%), two cardiovascular deaths and eight nonfatal cardiovascular events. The event rate was similar in the WCH group and the EH group and significantly lower in the NT group (P<0.05). When corrected for daytime-ABP, age and other confounders, the difference remained statistically significant. When using the lower cutoff of 135/85 mmHg, WCH was still associated with a significantly higher cardiovascular event rate. In conclusion, the main finding of this 10-year follow-up study is an increased cardiovascular risk in WCH compared to normotensive controls.
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Affiliation(s)
- P H Gustavsen
- Department of Internal Medicine, County Central Hospital, Naestved, Denmark.
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