title: Long-Term Stroke Risk Due to Partial White-Coat or Masked Hypertension Based on Home and Ambulatory Blood Pressure Measurements: The Ohasama Study.
abstract: The prognostic significance of white-coat hypertension (WCHT) is controversial, and different findings on self-measured home measurements and 24-h ambulatory monitoring make identifying WCHT difficult. We examined whether individuals with partially or completely defined WCHT, as well as masked hypertension, as determined by different out-of-office blood pressure measurements, have a distinct long-term stroke risk. We followed 1464 participants (31.8% men; mean age, 60.6±10.8 years) in the general population of Ohasama, Japan, for a median of 17.1 years. A first stroke occurred in 212 subjects. Using sustained normal blood pressure (events/n=61/776) as a reference, adjusted hazard ratios for stroke (95% confidence intervals; events/n) were 1.38 (0.82-2.32; 19/137) for complete WCHT (isolated office hypertension), 2.16 (1.36-3.43; 29/117) for partial WCHT (either home or ambulatory normotension with office hypertension), 2.05 (1.24-3.41; 23/100) for complete masked hypertension (both home and ambulatory hypertension with office normotension), 2.08 (1.37-3.16; 38/180) for partial masked hypertension (either home or ambulatory hypertension with office normotension), and 2.46 (1.61-3.77; 42/154) for sustained hypertension. When partial WCHT and partial masked hypertension groups were further divided into participants only with home hypertension and those only with ambulatory hypertension, all subgroups had a significantly higher stroke risk (adjusted hazard ratio ≥1.84, P≤0.04). In conclusion, impacts of partial WCHT as well as partial masked hypertension for long-term stroke risk were comparable to those of complete masked hypertension or sustained hypertension. We need both home and 24-h ambulatory blood pressure measurements to evaluate stroke risk accurately.
authors.affiliation: From the Department of Pharmaceutical Sciences (M.S., T. Obara, N.M.) and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.H, Y.I., T. Ohkubo); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., A.I., K.M., A.M., T. Ohkubo); Department of Preventive Medicine and Epidemiology (M.K., T. Obara), and Department of Community Medical Supports (H.M.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Medical Clinic of Foreign Ministry, Ministry of Foreign Affairs of Japan, Tokyo, Japan (D.Y.); and Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.). satoh.mchr@hosp.tohoku.ac.jp.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Satoh
authors.affiliation: From the Department of Pharmaceutical Sciences (M.S., T. Obara, N.M.) and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.H, Y.I., T. Ohkubo); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., A.I., K.M., A.M., T. Ohkubo); Department of Preventive Medicine and Epidemiology (M.K., T. Obara), and Department of Community Medical Supports (H.M.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Medical Clinic of Foreign Ministry, Ministry of Foreign Affairs of Japan, Tokyo, Japan (D.Y.); and Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.).
authors.forename: Kei
authors.initials: K
authors.lastname: Asayama
authors.affiliation: From the Department of Pharmaceutical Sciences (M.S., T. Obara, N.M.) and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.H, Y.I., T. Ohkubo); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., A.I., K.M., A.M., T. Ohkubo); Department of Preventive Medicine and Epidemiology (M.K., T. Obara), and Department of Community Medical Supports (H.M.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Medical Clinic of Foreign Ministry, Ministry of Foreign Affairs of Japan, Tokyo, Japan (D.Y.); and Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.).
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kikuya
authors.affiliation: From the Department of Pharmaceutical Sciences (M.S., T. Obara, N.M.) and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.H, Y.I., T. Ohkubo); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., A.I., K.M., A.M., T. Ohkubo); Department of Preventive Medicine and Epidemiology (M.K., T. Obara), and Department of Community Medical Supports (H.M.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Medical Clinic of Foreign Ministry, Ministry of Foreign Affairs of Japan, Tokyo, Japan (D.Y.); and Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.).
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Inoue
authors.affiliation: From the Department of Pharmaceutical Sciences (M.S., T. Obara, N.M.) and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.H, Y.I., T. Ohkubo); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., A.I., K.M., A.M., T. Ohkubo); Department of Preventive Medicine and Epidemiology (M.K., T. Obara), and Department of Community Medical Supports (H.M.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Medical Clinic of Foreign Ministry, Ministry of Foreign Affairs of Japan, Tokyo, Japan (D.Y.); and Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.).
authors.forename: Hirohito
authors.initials: H
authors.lastname: Metoki
authors.affiliation: From the Department of Pharmaceutical Sciences (M.S., T. Obara, N.M.) and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.H, Y.I., T. Ohkubo); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., A.I., K.M., A.M., T. Ohkubo); Department of Preventive Medicine and Epidemiology (M.K., T. Obara), and Department of Community Medical Supports (H.M.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Medical Clinic of Foreign Ministry, Ministry of Foreign Affairs of Japan, Tokyo, Japan (D.Y.); and Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.).
authors.forename: Miki
authors.initials: M
authors.lastname: Hosaka
authors.affiliation: From the Department of Pharmaceutical Sciences (M.S., T. Obara, N.M.) and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.H, Y.I., T. Ohkubo); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., A.I., K.M., A.M., T. Ohkubo); Department of Preventive Medicine and Epidemiology (M.K., T. Obara), and Department of Community Medical Supports (H.M.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Medical Clinic of Foreign Ministry, Ministry of Foreign Affairs of Japan, Tokyo, Japan (D.Y.); and Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.).
authors.forename: Megumi
authors.initials: M
authors.lastname: Tsubota-Utsugi
authors.affiliation: From the Department of Pharmaceutical Sciences (M.S., T. Obara, N.M.) and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.H, Y.I., T. Ohkubo); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., A.I., K.M., A.M., T. Ohkubo); Department of Preventive Medicine and Epidemiology (M.K., T. Obara), and Department of Community Medical Supports (H.M.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Medical Clinic of Foreign Ministry, Ministry of Foreign Affairs of Japan, Tokyo, Japan (D.Y.); and Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.).
authors.forename: Taku
authors.initials: T
authors.lastname: Obara
authors.affiliation: From the Department of Pharmaceutical Sciences (M.S., T. Obara, N.M.) and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.H, Y.I., T. Ohkubo); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., A.I., K.M., A.M., T. Ohkubo); Department of Preventive Medicine and Epidemiology (M.K., T. Obara), and Department of Community Medical Supports (H.M.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Medical Clinic of Foreign Ministry, Ministry of Foreign Affairs of Japan, Tokyo, Japan (D.Y.); and Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.).
authors.forename: Aya
authors.initials: A
authors.lastname: Ishiguro
authors.affiliation: From the Department of Pharmaceutical Sciences (M.S., T. Obara, N.M.) and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.H, Y.I., T. Ohkubo); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., A.I., K.M., A.M., T. Ohkubo); Department of Preventive Medicine and Epidemiology (M.K., T. Obara), and Department of Community Medical Supports (H.M.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Medical Clinic of Foreign Ministry, Ministry of Foreign Affairs of Japan, Tokyo, Japan (D.Y.); and Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.).
authors.forename: Keiko
authors.initials: K
authors.lastname: Murakami
authors.affiliation: From the Department of Pharmaceutical Sciences (M.S., T. Obara, N.M.) and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.H, Y.I., T. Ohkubo); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., A.I., K.M., A.M., T. Ohkubo); Department of Preventive Medicine and Epidemiology (M.K., T. Obara), and Department of Community Medical Supports (H.M.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Medical Clinic of Foreign Ministry, Ministry of Foreign Affairs of Japan, Tokyo, Japan (D.Y.); and Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.).
authors.forename: Ayako
authors.initials: A
authors.lastname: Matsuda
authors.affiliation: From the Department of Pharmaceutical Sciences (M.S., T. Obara, N.M.) and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.H, Y.I., T. Ohkubo); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., A.I., K.M., A.M., T. Ohkubo); Department of Preventive Medicine and Epidemiology (M.K., T. Obara), and Department of Community Medical Supports (H.M.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Medical Clinic of Foreign Ministry, Ministry of Foreign Affairs of Japan, Tokyo, Japan (D.Y.); and Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.).
authors.forename: Daisaku
authors.initials: D
authors.lastname: Yasui
authors.affiliation: From the Department of Pharmaceutical Sciences (M.S., T. Obara, N.M.) and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.H, Y.I., T. Ohkubo); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., A.I., K.M., A.M., T. Ohkubo); Department of Preventive Medicine and Epidemiology (M.K., T. Obara), and Department of Community Medical Supports (H.M.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Medical Clinic of Foreign Ministry, Ministry of Foreign Affairs of Japan, Tokyo, Japan (D.Y.); and Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.).
authors.forename: Takahisa
authors.initials: T
authors.lastname: Murakami
authors.affiliation: From the Department of Pharmaceutical Sciences (M.S., T. Obara, N.M.) and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.H, Y.I., T. Ohkubo); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., A.I., K.M., A.M., T. Ohkubo); Department of Preventive Medicine and Epidemiology (M.K., T. Obara), and Department of Community Medical Supports (H.M.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Medical Clinic of Foreign Ministry, Ministry of Foreign Affairs of Japan, Tokyo, Japan (D.Y.); and Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.).
authors.forename: Nariyasu
authors.initials: N
authors.lastname: Mano
authors.affiliation: From the Department of Pharmaceutical Sciences (M.S., T. Obara, N.M.) and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.H, Y.I., T. Ohkubo); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., A.I., K.M., A.M., T. Ohkubo); Department of Preventive Medicine and Epidemiology (M.K., T. Obara), and Department of Community Medical Supports (H.M.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Medical Clinic of Foreign Ministry, Ministry of Foreign Affairs of Japan, Tokyo, Japan (D.Y.); and Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.).
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Imai
authors.affiliation: From the Department of Pharmaceutical Sciences (M.S., T. Obara, N.M.) and Medical Information Technology Center (R.I.), Tohoku University Hospital, Sendai, Japan; Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., M.H, Y.I., T. Ohkubo); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., A.I., K.M., A.M., T. Ohkubo); Department of Preventive Medicine and Epidemiology (M.K., T. Obara), and Department of Community Medical Supports (H.M.), Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan; National Institute of Health and Nutrition, Tokyo, Japan (M.T.-U.); Medical Clinic of Foreign Ministry, Ministry of Foreign Affairs of Japan, Tokyo, Japan (D.Y.); and Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, Sendai, Japan (T.M.).
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors; D059466:White Coat Hypertension / Q000150:complications* / Q000503:physiopathology
keywords: blood pressure; epidemiology; hypertension; population; stroke