TY - JOUR
T1 - Significance of white-coat hypertension in older persons with isolated systolic hypertension
T2 - A meta-analysis using the international database on ambulatory blood pressure monitoring in relation to cardiovascular outcomes population
AU - Franklin, Stanley S.
AU - Thijs, Lutgarde
AU - Hansen, Tine W.
AU - Li, Yan
AU - Boggia, José
AU - Kikuya, Masahiro
AU - Björklund-Bodegård, Kristina
AU - Ohkubo, Takayoshi
AU - Jeppesen, Jørgen
AU - Torp-Pedersen, Christian
AU - Dolan, Eamon
AU - Kuznetsova, Tatiana
AU - Stolarz-Skrzypek, Katarzyna
AU - Tikhonoff, Valérie
AU - Malyutina, Sofia
AU - Casiglia, Edoardo
AU - Nikitin, Yuri
AU - Lind, Lars
AU - Sandoya, Edgardo
AU - Kawecka-Jaszcz, Kalina
AU - Imai, Yutaka
AU - Wang, Jiguang
AU - Ibsen, Hans
AU - O'Brien, Eoin
AU - Staessen, Jan A.
PY - 2012/3
Y1 - 2012/3
N2 - The significance of white-coat hypertension in older persons with isolated systolic hypertension remains poorly understood. We analyzed subjects from the population-based 11-country International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes database who had daytime ambulatory blood pressure (BP; ABP) and conventional BP (CBP) measurements. After excluding persons with diastolic hypertension by CBP (90 mm Hg) or by daytime ABP (85 mm Hg), a history of cardiovascular disease, and persons <18 years of age, the present analysis totaled 7295 persons, of whom 1593 had isolated systolic hypertension. During a median follow-up of 10.6 years, there was a total of 655 fatal and nonfatal cardiovascular events. The analyses were stratified by treatment status. In untreated subjects, those with white-coat hypertension (CBP 140/<90 mm Hg and ABP <135/<85 mm Hg) and subjects with normal BP (CBP <140/<90 mm Hg and ABP <135/<85 mm Hg) were at similar risk (adjusted hazard rate: 1.17 [95% CI: 0.87-1.57]; P=0.29). Furthermore, in treated subjects with isolated systolic hypertension, the cardiovascular risk was similar in elevated conventional and normal daytime systolic BP as compared with those with normal conventional and normal daytime BPs (adjusted hazard rate: 1.10 [95% CI: 0.79-1.53]; P=0.57). However, both treated isolated systolic hypertension subjects with white-coat hypertension (adjusted hazard rate: 2.00; [95% CI: 1.43-2.79]; P<0.0001) and treated subjects with normal BP (adjusted hazard rate: 1.98 [95% CI: 1.49-2.62]; P<0.0001) were at higher risk as compared with untreated normotensive subjects. In conclusion, subjects with sustained hypertension who have their ABP normalized on antihypertensive therapy but with residual white-coat effect by CBP measurement have an entity that we have termed, "treated normalized hypertension." Therefore, one should be cautious in applying the term "white-coat hypertension" to persons receiving antihypertensive treatment.
AB - The significance of white-coat hypertension in older persons with isolated systolic hypertension remains poorly understood. We analyzed subjects from the population-based 11-country International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes database who had daytime ambulatory blood pressure (BP; ABP) and conventional BP (CBP) measurements. After excluding persons with diastolic hypertension by CBP (90 mm Hg) or by daytime ABP (85 mm Hg), a history of cardiovascular disease, and persons <18 years of age, the present analysis totaled 7295 persons, of whom 1593 had isolated systolic hypertension. During a median follow-up of 10.6 years, there was a total of 655 fatal and nonfatal cardiovascular events. The analyses were stratified by treatment status. In untreated subjects, those with white-coat hypertension (CBP 140/<90 mm Hg and ABP <135/<85 mm Hg) and subjects with normal BP (CBP <140/<90 mm Hg and ABP <135/<85 mm Hg) were at similar risk (adjusted hazard rate: 1.17 [95% CI: 0.87-1.57]; P=0.29). Furthermore, in treated subjects with isolated systolic hypertension, the cardiovascular risk was similar in elevated conventional and normal daytime systolic BP as compared with those with normal conventional and normal daytime BPs (adjusted hazard rate: 1.10 [95% CI: 0.79-1.53]; P=0.57). However, both treated isolated systolic hypertension subjects with white-coat hypertension (adjusted hazard rate: 2.00; [95% CI: 1.43-2.79]; P<0.0001) and treated subjects with normal BP (adjusted hazard rate: 1.98 [95% CI: 1.49-2.62]; P<0.0001) were at higher risk as compared with untreated normotensive subjects. In conclusion, subjects with sustained hypertension who have their ABP normalized on antihypertensive therapy but with residual white-coat effect by CBP measurement have an entity that we have termed, "treated normalized hypertension." Therefore, one should be cautious in applying the term "white-coat hypertension" to persons receiving antihypertensive treatment.
KW - ambulatory blood pressure
KW - cardiovascular disease
KW - epidemiology
KW - isolated systolic hypertension
KW - white-coat effect
KW - white-coat hypertension
UR - http://www.scopus.com/inward/record.url?scp=84862777473&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84862777473&partnerID=8YFLogxK
U2 - 10.1161/HYPERTENSIONAHA.111.180653
DO - 10.1161/HYPERTENSIONAHA.111.180653
M3 - Article
C2 - 22252396
AN - SCOPUS:84862777473
SN - 0194-911X
VL - 59
SP - 564
EP - 571
JO - Hypertension
JF - Hypertension
IS - 3
ER -
