Reproducibility of white-coat and masked hypertension in ambulatory BP monitoring.
BACKGROUND
White-coat hypertension and masked hypertension have clinical and prognostic consequences. However, reproducibility of these phenomena is unknown. We examined the reproducibility of the white-coat and masking effects with real-life ambulatory blood pressure monitoring (ABPM).


METHODS
In a retrospective analysis of a prospectively assembled ABPM database there were 196 subjects (age 58+/-16 years, 59% female, 73% treated for hypertension) who underwent repeat ABPM for standard clinical indications. White-coat hypertension (or isolated manual uncontrolled hypertension) was defined as normal (<135/85 mmHg) awake blood pressure (BP) and abnormal (>or=140/90 mmHg) manual BP. Masked hypertension (or isolated ambulatory uncontrolled hypertension) was defined as abnormal awake BP with normal manual BP.


RESULTS
Treated and untreated subjects had similar distribution among hypertension subgroups; 16% white-coat hypertension (in treated subjects, isolated manual uncontrolled hypertension), 13% masked hypertension (in treated subjects, isolated ambulatory uncontrolled hypertension), 59% uncontrolled hypertension, 12% normal blood pressure (or controlled hypertension). In the second session the prevalence of white-coat and masked hypertension increased. Of 31 subjects with white-coat hypertension in the first session 19 (61%) remained ambulatory normotensive in the second session, while 18 of 25 (72%) masked hypertensive subjects remained ambulatory hypertensive. The reproducibility of the systolic manual-awake blood pressure difference was not inferior to that of other ambulatory variables. In untreated subjects the reproducibility of white-coat hypertension, masked hypertension and the white-coat effect was even better.


CONCLUSIONS
In a real-life ABPM database, we found white-coat hypertension and the masking phenomenon to be reasonably reproducible, as compared to other BP variables.
Ben-Dov
Iddo Z
IZ
Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Mount-Scopus Campus, Jerusalem 91240, Israel. bendovi@md.huji.ac.il
Ben-Arie
Liora
L
Mekler
Judith
J
Bursztyn
Michael
M
D001795:Blood Pressure Determination; D018660:Blood Pressure Monitoring, Ambulatory; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies