title: Prognosis of white-coat and masked hypertension: International Database of HOme blood pressure in relation to Cardiovascular Outcome.
abstract: Home blood pressure monitoring is useful in detecting white-coat and masked hypertension and is recommended for patients with suspected or treated hypertension. The prognostic significance of white-coat and masked hypertension detected by home measurement was investigated in 6458 participants from 5 populations enrolled in the International Database of HOme blood pressure in relation to Cardiovascular Outcomes. During a median follow-up of 8.3 years, 714 fatal plus nonfatal cardiovascular events occurred. Among untreated subjects (n=5007), cardiovascular risk was higher in those with white-coat hypertension (adjusted hazard ratio 1.42; 95% CI [1.06-1.91]; P=0.02), masked hypertension (1.55; 95% CI [1.12-2.14]; P<0.01) and sustained hypertension (2.13; 95% CI [1.66-2.73]; P<0.0001) compared with normotensive subjects. Among treated patients (n=1451), the cardiovascular risk did not differ between those with high office and low home blood pressure (white-coat) and treated controlled subjects (low office and home blood pressure; 1.16; 95% CI [0.79-1.72]; P=0.45). However, treated subjects with masked hypertension (low office and high home blood pressure; 1.76; 95% CI [1.23-2.53]; P=0.002) and uncontrolled hypertension (high office and home blood pressure; 1.40; 95% CI [1.02-1.94]; P=0.04) had higher cardiovascular risk than treated controlled patients. In conclusion, white-coat hypertension assessed by home measurements is a cardiovascular risk factor in untreated but not in treated subjects probably because the latter receive effective treatment on the basis of their elevated office blood pressure. In contrast, masked uncontrolled hypertension is associated with increased cardiovascular risk in both untreated and treated patients, who are probably undertreated because of their low office blood pressure.
authors.affiliation: Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Campus Sint Rafaël, Kapucijnenvoer 35, Block D, Box 7001, BE-3000 Leuven, Belgium. jan.staessen@med.kuleuven.be or jan.staessen@epid.unimaas.nl.
authors.forename: George S
authors.initials: GS
authors.lastname: Stergiou
authors.forename: Kei
authors.initials: K
authors.lastname: Asayama
authors.forename: Lutgarde
authors.initials: L
authors.lastname: Thijs
authors.forename: Anastasios
authors.initials: A
authors.lastname: Kollias
authors.forename: Teemu J
authors.initials: TJ
authors.lastname: Niiranen
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hozawa
authors.forename: José
authors.initials: J
authors.lastname: Boggia
authors.forename: Jouni K
authors.initials: JK
authors.lastname: Johansson
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
authors.forename: Ichiro
authors.initials: I
authors.lastname: Tsuji
authors.forename: Antti M
authors.initials: AM
authors.lastname: Jula
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Imai
authors.forename: Jan A
authors.initials: JA
authors.lastname: Staessen
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D059468:Masked Hypertension / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome; D059466:White Coat Hypertension / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents
keywords: cardiovascular diseases; home blood pressure monitoring; masked hypertension; meta-analysis; prognosis; white-coat hypertension