title: Similar levels of low-grade inflammation and arterial stiffness in masked and white-coat hypertension: comparisons with sustained hypertension and normotension.
abstract: OBJECTIVE
  The clinical significance of masked hypertension (MHT) and white-coat hypertension (WCHT) remains controversial, whereas subclinical inflammation and arterial stiffness are associated with an adverse prognosis. We examined the interrelationships of MHT, WCHT, and sustained hypertension (SHT) with high-sensitivity C-reactive protein (hs-CRP) and arterial stiffness.
  
  
  METHODS
  Our population consisted of 291 untreated nondiabetic patients with MHT [office blood pressure (BP) < 140/90 mmHg and daytime BP ≥ 135/85 mmHg; n = 32], WCHT (office BP ≥ 140/90 mmHg and daytime BP < 135/85 mmHg; n = 81), SHT (office BP ≥ 140/90 mmHg and daytime BP ≥ 135/85 mmHg; n = 178), and 44 age-matched and sex-matched control normotensives.
  
  
  RESULTS
  SHT compared with WCHT, MHT, and normotension exhibited higher pulse wave velocity (PWV; 8.2 ± 1.4 vs. 7.5 ± 1.2 vs. 7.3 ± 0.9 vs. 6.8 ± 0.5 m/s, respectively; P < 0.05) and hs-CRP (2.8 ± 0.7 vs. 2.2 ± 0.6 vs. 1.9 ± 0.4 vs. 1.2 ± 0.3 mg/l, respectively; P < 0.05), independently of confounders. Of note, there was no difference between the MHT and WCHT groups with regard to hs-CRP and PWV levels (P = not significant). In hypertensives, hs-CRP was associated with 24-h systolic BP (r = 0.350, P < 0.0001) and PWV (r = 0.228, P < 0.0001), whereas PWV was associated with 24-h systolic BP (r = 0.330, P < 0.0001).
  
  
  CONCLUSIONS
  MHT and WCHT represent two states of equivalent subclinical vascular dysfunction reflected by hs-CRP and PWV. Moreover, MHT and WCHT are characterized by a higher degree of inflammatory activation and arterial stiffening compared with normotension and by a lesser degree compared with SHT. The association of 24-h BP with both hs-CRP and PWV underscores the dominant role of hemodynamic load on hypertensive damage progression.
authors.affiliation: First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Andrikou
authors.forename: Costas
authors.initials: C
authors.lastname: Tsioufis
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Dimitriadis
authors.forename: Dimitris
authors.initials: D
authors.lastname: Syrseloudis
authors.forename: Panagiota
authors.initials: P
authors.lastname: Valenti
authors.forename: Mariota
authors.initials: M
authors.lastname: Almiroudi
authors.forename: Louiza
authors.initials: L
authors.lastname: Lioni
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tousoulis
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D001794:Blood Pressure / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D002097:C-Reactive Protein / Q000032:analysis; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D007249:Inflammation / Q000150:complications; D008297:Male; D059468:Masked Hypertension / Q000150:complications*; D008875:Middle Aged; D011379:Prognosis; D011673:Pulsatile Flow; D059289:Vascular Stiffness; D059466:White Coat Hypertension / Q000150:complications*
chemical_list: D002097:C-Reactive Protein