title: White-coat and masked hypertension are associated with carotid atherosclerosis in a general population: the Hisayama study.
abstract: OBJECTIVE
  On the basis of combined measurements of clinic blood pressure (CBP) and home blood pressure (HBP), blood pressure status can be divided into normotension, white-coat hypertension (WCHT), masked hypertension (MHT), and sustained hypertension (SHT). Despite the clear impact of MHT and SHT on clinical and subclinical arterial disease, uncertainty about the influence of WCHT remains. The objective of this study was to investigate the associations of WCHT, MHT, and SHT with carotid atherosclerosis in a general population.
  
  
  METHODS
  This is a cross-sectional survey of 2915 community-dwelling Japanese aged ≥ 40 years. Normotension was defined as CBP<140/90 and HBP<135/85 mm Hg; WCHT, CBP ≥ 140/90 and HBP<135/85 mm Hg; MHT, CBP<140/90 and HBP ≥ 135/85 mm Hg; and SHT, CBP ≥ 140/90 and HBP ≥ 135/85 mm Hg. Mean intima-media thickness of carotid arteries was measured using a computer-automated system, and carotid stenosis was defined as diameter stenosis ≥ 30%.
  
  
  RESULTS
  There were 1374 subjects (47.1%) with normotension, 200 (6.9%) with WCHT, 639 (21.9%) with MHT, and 702 (24.1%) with SHT. The geometric average of mean intima-media thickness was significantly higher among subjects with WCHT (0.73 mm), MHT (0.77 mm), and SHT (0.77 mm) than those with normotension (0.67 mm; all P<0.001 versus normotension). Compared with normotension, all types of hypertension were also associated with increased likelihood of carotid stenosis (age- and sex-adjusted odds ratio, 2.36 [95% confidence interval, 1.27-4.37] for WCHT, 1.95 [1.25-3.03] for MHT, and 3.02 [2.01-4.54] for SHT). These associations remained significant even after adjustment for other cardiovascular risk factors.
  
  
  CONCLUSIONS
  WCHT, as well as MHT, and SHT were associated with carotid atherosclerosis in a general Japanese population.
authors: Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
authors: Masayo
authors: M
authors: Fukuhara
authors: Hisatomi
authors: H
authors: Arima
authors: Toshiharu
authors: T
authors: Ninomiya
authors: Jun
authors: J
authors: Hata
authors: Yoichiro
authors: Y
authors: Hirakawa
authors: Yasufumi
authors: Y
authors: Doi
authors: Koji
authors: K
authors: Yonemoto
authors: Naoko
authors: N
authors: Mukai
authors: Masaharu
authors: M
authors: Nagata
authors: Fumie
authors: F
authors: Ikeda
authors: Kiyoshi
authors: K
authors: Matsumura
authors: Takanari
authors: T
authors: Kitazono
authors: Yutaka
authors: Y
authors: Kiyohara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000208:ethnology; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D002340:Carotid Artery Diseases / Q000150:complications* / Q000175:diagnosis* / Q000208:ethnology; D059168:Carotid Intima-Media Thickness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D059468:Masked Hypertension / Q000453:epidemiology* / Q000208:ethnology / Q000503:physiopathology; D008875:Middle Aged; D009819:Office Visits; D012307:Risk Factors; D059466:White Coat Hypertension / Q000453:epidemiology* / Q000208:ethnology / Q000503:physiopathology
keywords: atherosclerosis; clinic blood pressure; home blood pressure; intima-media thickness; masked hypertension; white-coat hypertension