Setting thresholds to varying blood pressure monitoring intervals differentially affects risk estimates associated with white-coat and masked hypertension in the population

Kei Asayama, Lutgarde Thijs, Yan Li, Yu Mei Gu, Azusa Hara, Yan Ping Liu, Zhenyu Zhang, Fang Fei Wei, Inés Lujambio, Luis J. Mena, José Boggia, Tine W. Hansen, Kristina Björklund-Bodegard, Kyoko Nomura, Takayoshi Ohkubo, Jørgen Jeppesen, Christian Torp-Pedersen, Eamon Dolan, Katarzyna Stolarz-Skrzypek, Sofia MalyutinaEdoardo Casiglia, Yuri Nikitin, Lars Lind, Leonella Luzardo, Kalina Kawecka-Jaszcz, Edgardo Sandoya, Jan Filipovský, Gladys E. Maestre, Jiguang Wang, Yutaka Imai, Stanley S. Franklin, Eoin O'Brien, Jan A. Staessen

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Outcome-driven recommendations about time intervals during which ambulatory blood pressure should be measured to diagnose white-coat or masked hypertension are lacking. We cross-classified 8237 untreated participants (mean age, 50.7 years; 48.4% women) enrolled in 12 population studies, using ≥140/≥90, ≥130/≥80, ≥135/≥85, and ≥120/≥70 mm Hg as hypertension thresholds for conventional, 24-hour, daytime, and nighttime blood pressure. White-coat hypertension was hypertension on conventional measurement with ambulatory normotension, the opposite condition being masked hypertension. Intervals used for classification of participants were daytime, nighttime, and 24 hours, first considered separately, and next combined as 24 hours plus daytime or plus nighttime, or plus both. Depending on time intervals chosen, white-coat and masked hypertension frequencies ranged from 6.3% to 12.5% and from 9.7% to 19.6%, respectively. During 91 046 person-years, 729 participants experienced a cardiovascular event. In multivariable analyses with normotension during all intervals of the day as reference, hazard ratios associated with white-coat hypertension progressively weakened considering daytime only (1.38; P=0.033), nighttime only (1.43; P=0.0074), 24 hours only (1.21; P=0.20), 24 hours plus daytime (1.24; P=0.18), 24 hours plus nighttime (1.15; P=0.39), and 24 hours plus daytime and nighttime (1.16; P=0.41). The hazard ratios comparing masked hypertension with normotension were all significant (P<0.0001), ranging from 1.76 to 2.03. In conclusion, identification of truly low-risk white-coat hypertension requires setting thresholds simultaneously to 24 hours, daytime, and nighttime blood pressure. Although any time interval suffices to diagnose masked hypertension, as proposed in current guidelines, full 24-hour recordings remain standard in clinical practice.

Original languageEnglish
Pages (from-to)935-942
Number of pages8
JournalHypertension
Volume64
Issue number5
DOIs
Publication statusPublished - 2014 Nov 1
Externally publishedYes

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Keywords

  • Ambulatory blood pressure monitoring
  • Cardiovascular risk
  • Masked hypertension
  • Population science
  • White-coat hypertension

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Asayama, K., Thijs, L., Li, Y., Gu, Y. M., Hara, A., Liu, Y. P., Zhang, Z., Wei, F. F., Lujambio, I., Mena, L. J., Boggia, J., Hansen, T. W., Björklund-Bodegard, K., Nomura, K., Ohkubo, T., Jeppesen, J., Torp-Pedersen, C., Dolan, E., Stolarz-Skrzypek, K., ... Staessen, J. A. (2014). Setting thresholds to varying blood pressure monitoring intervals differentially affects risk estimates associated with white-coat and masked hypertension in the population. Hypertension, 64(5), 935-942. https://doi.org/10.1161/HYPERTENSIONAHA.114.03614