Detection of carotid atherosclerosis in individuals with masked hypertension and white-coat hypertension by self-measured blood pressure at home: the Ohasama study.
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.
Hara
Azusa
A
Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences and Medicine, Sendai, Japan.
Ohkubo
Takayoshi
T
Kikuya
Masahiro
M
Shintani
Yoriko
Y
Obara
Taku
T
Metoki
Hirohito
H
Inoue
Ryusuke
R
Asayama
Kei
K
Hashimoto
Takanao
T
Harasawa
Toshiya
T
Aono
Yoko
Y
Otani
Harunori
H
Tanaka
Kazushi
K
Hashimoto
Junichiro
J
Totsune
Kazuhito
K
Hoshi
Haruhisa
H
Satoh
Hiroshi
H
Imai
Yutaka
Y
D000368:Aged; D050197:Atherosclerosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D018660:Blood Pressure Monitoring, Ambulatory; D015992:Body Mass Index; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis*; D008403:Mass Screening; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D018570:Risk Assessment