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Habas E, Errayes A, Habas E, Alfitori G, Habas A, Farfar K, Rayani A, Habas A, Elzouki AN. Masked phenomenon: renal and cardiovascular complications; review and updates. Blood Press 2024; 33:2383234. [PMID: 39056371 DOI: 10.1080/08037051.2024.2383234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/10/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND In the in-clinic blood pressure (BP) recording setting, a sizable number of individuals with normal BP and approximately 30% of patients with chronic renal disease (CKD) exhibit elevated outpatient BP records. These individuals are known as masked hypertension (MHTN), and when they are on antihypertensive medications, but their BP is not controlled, they are called masked uncontrolled hypertension (MUHTN). The masked phenomenon (MP) (MHTN and MUHTN) increases susceptibility to end-organ damage (a two-fold greater risk for cardiovascular events and kidney dysfunction). The potential extension of the observed benefits of MP therapy, including a reduction in end-organ damage, remains questionable. AIM AND METHODS This review aims to study the diagnostic methodology, epidemiology, pathophysiology, and significance of MP management in end-organs, especially the kidneys, cardiovascular system, and outcomes. To achieve the purposes of this non-systematic comprehensive review, PubMed, Google, and Google Scholar were searched using keywords, texts, and phrases such as masked phenomenon, CKD and HTN, HTN types, HTN definition, CKD progression, masked HTN, MHTN, masked uncontrolled HTN, CKD onset, and cardiovascular system and MHTN. We restricted the search process to the last ten years to search for the latest updates. CONCLUSION MHTN is a variant of HTN that can be missed if medical professionals are unaware of it. Early detection by ambulatory or home BP recording in susceptible individuals reduces end-organ damage and progresses to sustained HTN. Adherence to the available recommendations when dealing with masked phenomena is justifiable; however, further studies and recommendation updates are required.
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Affiliation(s)
- Elmukhtar Habas
- Medical Department, Hamad General Hospital, Qatar University, Doha, Qatar
| | - Almehdi Errayes
- Medical Department, Hamad General Hospital, Qatar University, Doha, Qatar
| | - Eshrak Habas
- Internal Medicine, Medical Department, Tripoli Central Hospital, University of Tripoli, Tripoli, Libya
| | - Gamal Alfitori
- Medical Department, Hamad General Hospital, Qatar University, Doha, Qatar
| | - Ala Habas
- Medical Department, Alwakra General Hospital, Qatar University, Alwakra, Qatar
| | - Kalifa Farfar
- Medical Department, Alwakra General Hospital, Qatar University, Alwakra, Qatar
| | - Amnna Rayani
- Tripoli Children Hospital, University of Tripoli, Tripoli, Libya
| | - Aml Habas
- Tripoli Children Hospital, University of Tripoli, Tripoli, Libya
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Faye M, Faye M, Lemrabott AT, Cisse MM, Fall K, Ismael Keita AR, Mbengue M, Ba B, Keita N, Diagne S, Niang A, Diouf B, Ka EHF. Evaluation of blood pressure profile in chronic hemodialysis patients using two measurement methods: Home blood pressure measurement and conventional measurement. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2019; 30:1038-1043. [PMID: 31696841 DOI: 10.4103/1319-2442.270258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The monitoring of hypertension (HTN) in dialysis is often delicate with potentially false measurements due to the white coat effect on the one hand and masked HTN (M-HTN) on the other hand. In this population, there is much controversy over the ideal moment for taking blood pressure (BP) and the target values. An answer to these questions is given by home BP measurement that can detect white coat HTN (WC-HTN) and M-HTN. The aim of this study was to determine the respective prevalence of permanent HTN (P-HTN), WC-HTN, M-HTN, and permanently normotensive (P-NTN) in this population and to analyze the risk factors of M-HTN and WC-HTN in hemodialysis (HD) centers in sub-Saharan Africa. This was a multicenter, descriptive, and analytical cross-sectional study conducted over a period of one month and 23 days. Data collection was performed using a home BP measurement form, conventional BP measurement form, and clinical and laboratory data collection form. The study included all patients who could take their BP at home using an electronic BP machine and record results on the BP forms. All analyses were performed using the Sphinx plus software version 5. The significance level for all statistical tests was set at 5%. The mean age of patients was 45.57 years ± 14.11, with a sex ratio of 1.42. The mean duration in dialysis was 57.96 months ± 34.86. Adherence to the home BP measurement was 100% in 71.7%. P-NTN patients were 15.2% (7 patients), WC-HTN patients were 13% (6 patients), M-HTN patients were 17.5% (8 patients), and P-HTN patients were 54.3% (25 patients). A statistically significant association was observed between WC-HTN and age (P = 0.01). In this work, we noted an important proportion of M-HTN and WC-HTN. This result confirms the need for home BP measurement in the follow-up of BP in HD patients.
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Affiliation(s)
- Maria Faye
- Department of Nephrology, Cheikh Anta Diop University; Department of Nephrology, Aristide Le Dantec University Hospital, Dakar, Senegal
| | - Moustapha Faye
- Department of Nephrology, Cheikh Anta Diop University; Department of Nephrology, Aristide Le Dantec University Hospital, Dakar, Senegal
| | - Ahmed Tall Lemrabott
- Department of Nephrology, Cheikh Anta Diop University; Department of Nephrology, Aristide Le Dantec University Hospital, Dakar, Senegal
| | | | - Kodia Fall
- Department of Nephrology, Aristide Le Dantec University Hospital, Dakar, Senegal
| | | | - Mansour Mbengue
- Department of Nephrology, Aristide Le Dantec University Hospital, Dakar, Senegal
| | - Bacary Ba
- Department of Nephrology, Aristide Le Dantec University Hospital, Dakar, Senegal
| | - Niakhaleen Keita
- Department of Nephrology, Aristide Le Dantec University Hospital, Dakar, Senegal
| | - Seynabou Diagne
- Department of Nephrology, Aristide Le Dantec University Hospital, Dakar, Senegal
| | - Abdou Niang
- Department of Nephrology, Cheikh Anta Diop University; Department of Nephrology, Aristide Le Dantec University Hospital, Dakar, Senegal
| | - Boucar Diouf
- Department of Nephrology, Cheikh Anta Diop University; Department of Nephrology, Aristide Le Dantec University Hospital, Dakar, Senegal
| | - El Hadji Fary Ka
- Department of Nephrology, Cheikh Anta Diop University; Department of Nephrology, Aristide Le Dantec University Hospital, Dakar, Senegal
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Presta V, Figliuzzi I, Citoni B, Miceli F, Battistoni A, Musumeci MB, Coluccia R, De Biase L, Ferrucci A, Volpe M, Tocci G. Effects of different statin types and dosages on systolic/diastolic blood pressure: Retrospective analysis of 24-hour ambulatory blood pressure database. J Clin Hypertens (Greenwich) 2018; 20:967-975. [DOI: 10.1111/jch.13283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/23/2018] [Accepted: 03/11/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Vivianne Presta
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | - Ilaria Figliuzzi
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | - Barbara Citoni
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | - Francesca Miceli
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | - Allegra Battistoni
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | - Maria Beatrice Musumeci
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | | | - Luciano De Biase
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | - Andrea Ferrucci
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | - Massimo Volpe
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
- IRCCS Neuromed; Pozzilli Italy
| | - Giuliano Tocci
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
- IRCCS Neuromed; Pozzilli Italy
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Favourable impact of statin use on diastolic blood pressure levels: analysis of a large database of 24-hour ambulatory blood pressure monitoring. J Hypertens 2018; 35:2086-2094. [PMID: 28582284 DOI: 10.1097/hjh.0000000000001419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Assumption of lipid-lowering drugs, mostly statins, is recommended at bed-time and evidence demonstrated a strong and independent correlation between night-time blood pressure (BP) and increased risk of cardiovascular events. AIM To evaluate the effects of statins on night-time BP levels. METHODS We analysed data derived from a large cohort of adult individuals, who consecutively underwent home, clinic and ambulatory BP monitoring at our Unit. All BP measurements were performed and BP thresholds were set according to recommendations from European guidelines. Study population was stratified according to statin use. RESULTS We included an overall sample of 5634 adult individuals (women 48.9%, age 60.5 ± 11.6 years, BMI 27.0 ± 4.6 kg/m, clinic BP 144.3 ± 18.4/90.9 ± 12.4 mmHg, 24-h BP 130.7 ± 13.4/79.0 ± 9.7 mmHg), among whom 17.3% received and 82.7% did not received statins. Treated outpatients were older, had higher BMI and prevalence of risk factors and comorbidities than those who were untreated (P < 0.001 for all). Patients treated with statins showed lower DBP levels at all BP measurements, including night-time (67.3 ± 9.4 vs. 70.9 ± 9.7 mmHg; P < 0.001) periods, than those observed in untreated patients. Also, statin use resulted an independent factor associated with 24-h [odds ratio (95% confidence interval): 1.513(1.295-1.767); P < 0.001] and night-time [odds ratio (95% confidence interval): 1.357(1.161-1.587); P < 0.001] BP control, even after adjusting for age, sex, BMI, diabetes, number of antihypertensive drugs (model 1) or presence/absence of antihypertensive treatment (model 2). CONCLUSION Statin use was associated with significantly lower DBP levels. These effects were independently observed, even after correction for cardiovascular risk factors and comorbidities, as well as number of antihypertensive drugs.
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Novello MF, Rosa MLG, Ferreira RT, Nunes IG, Jorge AJL, Correia DMDS, Martins WDA, Mesquita ET. Compliance with the Prescription of Antihypertensive Medications and Blood Pressure Control in Primary Care. Arq Bras Cardiol 2017; 108:135-142. [PMID: 28327875 PMCID: PMC5344658 DOI: 10.5935/abc.20170009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 10/18/2016] [Indexed: 01/13/2023] Open
Abstract
Background Hypertension is the most prevalent risk factor for cardiovascular disease,
and its proper control can prevent the high morbidity and mortality
associated with this disease. Objective To assess the degree of compliance of antihypertensive prescriptions with the
VI Brazilian Guidelines on Hypertension and the blood pressure control rate
in primary care. Methods Cross-sectional study conducted between August 2011 and November 2012,
including 332 adults ≥ 45 years registered in the Family Doctor
Program in Niteroi and selected randomly. The analysis included the
prescribed antihypertensive classes, doses, and frequencies, as well as the
blood pressure (BP) of the individuals. Results The rate of prescription compliance was 80%. Diuretics were the most
prescribed medications, and dual therapy was the most used treatment. The
most common non-compliances were underdosing and underfrequencies. The BP
goal in all cases was < 140/90 mmHg, except for diabetic patients, in
whom the goal was set at < 130/80 mmHg. Control rates according to these
goals were 44.9% and 38.6%, respectively. There was no correlation between
prescription compliance and BP control. Conclusions The degree of compliance was considered satisfactory. The achievement of the
targets was consistent with national and international studies, suggesting
that the family health model is effective in BP management, although it
still needs improvement.
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Affiliation(s)
- Mayra Faria Novello
- Departamento de Medicina Clínica - Universidade Federal Fluminense, Niterói, RJ - Brazil
| | - Maria Luiza Garcia Rosa
- Departamento de Epidemiologia e Bioestatística - Universidade Federal Fluminense, Niterói, RJ - Brazil
| | - Ranier Tagarro Ferreira
- Departamento de Epidemiologia e Bioestatística - Universidade Federal Fluminense, Niterói, RJ - Brazil
| | - Icaro Gusmão Nunes
- Departamento de Epidemiologia e Bioestatística - Universidade Federal Fluminense, Niterói, RJ - Brazil
| | | | - Dayse Mary da Silva Correia
- Departamento de Fundamentos de Enfermagem e Administração - Universidade Federal Fluminense, Niterói, RJ - Brazil
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Qu TT, Deng JX, Li RL, Cui ZJ, Wang XQ, Wang L, Deng JB. Stress injuries and autophagy in mouse hippocampus after chronic cold exposure. Neural Regen Res 2017; 12:440-446. [PMID: 28469659 PMCID: PMC5399722 DOI: 10.4103/1673-5374.202932] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Cold exposure is an external stress factor that causes skin frostbite as well as a variety of diseases. Estrogen might participate in neuroprotection after cold exposure, but its precise mechanism remains unclear. In this study, mice were exposed to 10°C for 7 days and 0-4°C for 30 days to induce a model of chronic cold exposure. Results showed that oxidative stress-related c-fos and cyclooxygenase 2 expressions, MAP1LC3-labeled autophagic cells, Iba1-labeled activated microglia, and interleukin-1β-positive pyramidal cells were increased in the hippocampal CA1 area. Chronic cold exposure markedly elevated the levels of estrogen in the blood and the estrogen receptor, G protein-coupled receptor 30. These results indicate that neuroimmunoreactivity is involved in chronic cold exposure-induced pathological alterations, including oxidative stress, neuronal autophagy, and neuroimmunoreactivity. Moreover, estrogen exerts a neuroprotective effect on cold exposure.
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Affiliation(s)
- Ting-Ting Qu
- Institute of Neurobiology, College of Life Science, Henan University, Kaifeng, Henan Province, China.,Nursing College, Henan Vocational College of Applied Technology, Zhengzhou, Henan Province, China
| | - Jie-Xin Deng
- Institute of Neurobiology, College of Life Science, Henan University, Kaifeng, Henan Province, China
| | - Rui-Ling Li
- Institute of Neurobiology, College of Life Science, Henan University, Kaifeng, Henan Province, China
| | - Zhan-Jun Cui
- Institute of Neurobiology, College of Life Science, Henan University, Kaifeng, Henan Province, China
| | - Xiao-Qing Wang
- Institute of Neurobiology, College of Life Science, Henan University, Kaifeng, Henan Province, China
| | - Lai Wang
- Institute of Neurobiology, College of Life Science, Henan University, Kaifeng, Henan Province, China
| | - Jin-Bo Deng
- Institute of Neurobiology, College of Life Science, Henan University, Kaifeng, Henan Province, China
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7
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Algamal AM. Frequency of masked hypertension and its relation to target organ damage in the heart. Egypt Heart J 2016. [DOI: 10.1016/j.ehj.2015.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Yue WW, Yin J, Chen B, Zhang X, Wang G, Li H, Chen H, Jia RY. Analysis of heart rate variability in masked hypertension. Cell Biochem Biophys 2015; 70:201-4. [PMID: 24639105 DOI: 10.1007/s12013-014-9882-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To investigate heart rate variability (HRV) in patients with masked hypertension (MH), participants were classified based on clinic and 24-h ambulatory blood-pressure monitoring: essential hypertension (EH, n = 40; MH, n = 36) and normotension (NT, n = 48). The HRV parameters were observed using a 24-h Holter monitor. Compared with NT controls, the parameters of HRV (SDNN, SDANN, SDNN Index, RMSSD, HF) and parameters in EH and MH patients had significantly decreased. No statistically significant difference in the HRV parameters was found between the EH and MH groups. The changes in HRV parameters show cardiac autonomic nerve dysfunction in patients with MH.
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Affiliation(s)
- Wen-wei Yue
- The Fourth People's Hospital of Ji'nan, Ji'nan Institute of Cardiovascular Disease, Second Affiliated Hospital, Tai Shan Medical College, Jinan, 250031, China
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Nascimento LR, Molina MDCB, Faria CP, Cunha RDS, Mill JG. [Reproducibility of arterial pressure measured in the ELSA-Brasil with 24-hour pressure monitoring]. Rev Saude Publica 2014; 47 Suppl 2:113-21. [PMID: 24346728 DOI: 10.1590/s0034-8910.2013047003825] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 07/02/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To determine the reproducibility of casual arterial pressure measurement and to confirm pressure diagnosis by monitoring of participants in the ELSA-Brasil (Estudo Longitudinal de Saúde do Adulto - Brazilian Longitudinal Study for Adult Health). METHODS Casual blood pressure was measured with an oscilometric device. A sub-sample of participants (N = 255) from Espírito Santo state (Southeastern Brazil) was reevaluated using the same methodology following one to ten weeks and, in addition, underwent arterial blood pressure monitoring. Diagnosis of hypertension used cut off points of 140/90 mmHg for casual pressure and 130/80 mmHg for arterial blood pressure monitoring. White coat hypertension was defined as the presence of hypertension in casual blood pressure and normal arterial blood pressure monitoring, and converse findings characterized masked hypertension. RESULTS Data are from 230 participants that on the two occasions were free from antihypertensive medication (N1 = 153) or under the same antihypertensive regimen (N2 = 77). Normotension was confirmed by arterial blood pressure monitoring in 120 out of 134 participants of the N1 group. In N2, blood pressure control was confirmed by arterial blood pressure monitoring in 43 of 54 participants with controlled hypertension per casual blood pressure. Overall diagnostic concordance between casual blood pressure and arterial blood pressure monitoring was 78% (kappa = 0.44). In the N1 group, six subjects (4%) presented white coat hypertension, and 23 subjects (25%) presented with masked hypertension. CONCLUSIONS Diagnostic concordance between casual blood pressure and arterial blood pressure monitoring was moderate. The rigorous standardization of casual blood pressure measurement adopted in the ELSA-Brasil study was able to reduce white coat hypertension. The high frequency of masked hypertension may suggest that pressure values obtained by arterial blood pressure monitoring indicate an elevated degree of stress at work.
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Palatini P. How should we manage a patient with masked hypertension? High Blood Press Cardiovasc Prev 2014; 22:11-6. [PMID: 24500867 DOI: 10.1007/s40292-014-0044-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 01/28/2014] [Indexed: 01/02/2023] Open
Abstract
A number of studies have shown that masked hypertension (MH) confers an increased risk of target organ damage and of cardiovascular events suggesting that patients with MH would benefit from antihypertensive treatment. However, there is no general agreement about how this condition should be diagnosed. Although ambulatory blood pressure monitoring (ABPM) and self blood pressure measurement (SBPM) provide different and complementary clinical information, the recently published ESH/ESC guidelines for the management of arterial hypertension suggest that for initial assessment of the patient, SBPM may be more suitable in primary care and ABPM in specialist care. If SBPM provides borderline values it is advisable to confirm the diagnosis of MH with ABPM. As the prevalence of MH declines with repeated ABPMs the diagnosis of MH should be based on at least two ABPMs. Patients with MH should undergo a careful diagnostic work-up to assess the existence of additional risk factors including a worsened metabolic profile and the presence of target organ involvement. Treatment of the patient with MH should initially be addressed to improve the patient's lifestyle in order to decrease out-of-office blood pressure and to ameliorate metabolic data. If non-pharmacological measures are insufficient to normalize blood pressure, MH may benefit from pharmacological treatment but no clinical trial has been implemented as yet with the specific purpose of testing this hypothesis. Despite this lack of evidence, the 2013 ESH/ESC guidelines have recommended that in patients with MH also drug treatment should be considered because in patients with MH the risk of adverse outcome is very close to that in sustained hypertension. When ambulatory blood pressure is measured, pharmacological treatment may be modulated according to whether blood pressure is elevated during daytime hours or during sleep.
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Affiliation(s)
- Paolo Palatini
- Department of Medicine, University of Padova, via Giustiniani 2, 35128, Padua, Italy,
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Cacciolati C, Hanon O, Alperovitch A, Dufouil C, Tzourio C. Masked hypertension in the elderly: cross-sectional analysis of a population-based sample. Am J Hypertens 2011; 24:674-80. [PMID: 21415840 DOI: 10.1038/ajh.2011.23] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Masked hypertension (MHT), defined as normal blood pressure (BP) at office associated with high BP at home, has been shown to be associated with an increased risk of vascular events. However, MHT is poorly known in the elderly, although this age segment is at high risk of hypertension-related vascular events. Our objectives were to assess frequency and determinants of MHT in the elderly. METHODS We studied MHT in a community-based sample of 1,814 participants aged 75 years or older, whose office BP and home BP measurements (HBPM) were both taken with the same device (Omron M6; Omron Healthcare, Kyoto, Japan).Hypertension was defined as a systolic BP (SBP) ≥ 140 mm Hg and/or a diastolic BP (DBP) ≥ 90 mm Hg for office BP, and SBP ≥ 135 mm Hg and/or DBP ≥ 85 mm Hg for HBPM. RESULTS Frequency of MHT was 16% in the overall sample and 41% in participants with a normal office BP. Multivariable analyses revealed that male subjects, >80 years of age, with diabetes, on antihypertensive medication, and with office SBP >120 mm Hg were independently associated with a higher risk of MHT. CONCLUSION MHT is frequent in the elderly and is associated with a high vascular profile. These results should encourage a more widespread use of home BP monitoring in this age segment.
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Abstract
The diagnosis of masked hypertension has been made easier with the widespread availability of home blood pressure monitoring devices with levels of accuracy comparable to ambulatory blood pressure monitoring. The negative impact of masked hypertension on cardiovascular morbidity and mortality is evidenced by numerous well-designed clinic-based and population-based studies. The relationship of masked hypertension and target organ damage is also well documented. These two factors, combined with the robust evidence of reduced cardiovascular morbidity and mortality achieved with blood pressure treatment, makes the argument for actively identifying patients with masked hypertension and prescribing treatment similar to that for patients with sustained hypertension. In this paper, we review the evidence for the cardiovascular prognosis of masked hypertension compared with sustained hypertension, we review its impact on target organ damage, we propose an algorithm for the treatment of patients with masked hypertension, and we point out the pitfalls in adopting such an approach.
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Park SJ, Park JB, Choi DJ, Youn HJ, Park CG, Ahn YK, Shin JH, Kim DW, Rim SJ, Bae JH, Park HY. Detection of masked hypertension and the 'mask effect' in patients with well-controlled office blood pressure. Circ J 2010; 75:357-65. [PMID: 21048328 DOI: 10.1253/circj.cj-10-0492] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Masked hypertension (MH) is characterized by its hidden nature and poor prognosis. However, it is not practical to routinely recommend home or ambulatory blood pressure monitoring (HBP or AMBP) to all patients with apparently well-controlled BP. The purpose of this study is to present, within the group of patients with well-controlled office BP (OBP), the clinical predictors of MH and to evaluate the gap (ie, the `mask effect' (ME)) between OBP and HBP. METHODS AND RESULTS BP was measured at the outpatient clinic and at home in 1,019 treated hypertensive patients. Candidate predictors for MH were analyzed within 511 patients with well-controlled OBP (45.6% men, 57.1±9.0 years). Among them, the prevalence of MH was 20.9% (n=107). In the multivariate-adjusted analysis, the risk of MH increased with high serum fasting blood glucose level (odds ratio (OR) 1.009, 95% confidence interval (CI): 1.001-1.018, P=0.020), higher systolic OBP (OR 1.075, 95%CI 1.045-1.106, P<0.001), higher diastolic OBP (OR 1.045, 95%CI 1.007-1.084, P=0.019) and the number of antihypertensive medications (OR 1.320, 95%CI 1.113-1.804, P=0.021). Furthermore, systolic HBP correlated well with systolic OBP (r=0.351, P<0.001) and with the degree of systolic ME (r=-0.672, P<0.001). CONCLUSIONS To recognize MH, it is practical to investigate those patients who are taking multiple antihypertensive drugs and have a high OBP with a high FBG level. The term "ME" identifies MH more appropriately than the term "negative white-coat effect".
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Affiliation(s)
- Sung-Ji Park
- SungKyunKwan University, Samsung Medical Center, Seoul, Republic of Korea
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15
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Abstract
Because of shortcomings of the office blood pressure (BP) measurement in individuals with hypertension (eg, white coat and masked hypertension effects, terminal digit bias, and large variability in BP among a small number of readings), use of out-of-office blood pressure measurements has become more common in clinical practice. The presence of the syndromes of white-coat and masked hypertension creates the concern that the office BP measurements are not reflective of an individual patient's true BP values. Home (or self) and ambulatory BP assessments have been used in numerous types of clinical trials and have demonstrated their usefulness as reliable research and clinical tools. In this article, we review the recent literature on the benefits and limitations of home (self) and ambulatory monitoring of the BP in clinical practice. In particular, how it relates to the diagnosis of patients with various presentations of hypertension and to cardio-vascular outcomes with long-term follow-ups of population cohorts.
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Affiliation(s)
- Nimrta Ghuman
- Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030-3940, USA
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Banegas JR, Segura J, de la Sierra A, Gorostidi M, Rodríguez-Artalejo F, Sobrino J, de la Cruz JJ, Vinyoles E, del Rey RH, Graciani A, Ruilope LM. Gender differences in office and ambulatory control of hypertension. Am J Med 2008; 121:1078-84. [PMID: 19028204 DOI: 10.1016/j.amjmed.2008.06.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2008] [Revised: 05/13/2008] [Accepted: 06/12/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Gender differences in hypertension control have not been explored fully. METHODS We studied 15,212 white men and 13,936 white women with treated hypertension who were drawn from the Spanish Ambulatory Blood Pressure Registry. For each participant, we obtained office blood pressure (BP) (average of 2 readings) and 24-hour ambulatory BP (average of measurements performed every 20 minutes during day and night). RESULTS Only 16.4% of women and 14.7% of men had both office (<140/90 mm Hg) and ambulatory (<130/80 mm Hg) BP controlled (P<.001). Women had a lower frequency of masked hypertension (office BP<140/90 mm Hg and ambulatory BP> or =130/80 mm Hg) than men (5.9% vs 7.9%, P<.001). Women had a higher frequency of isolated office hypertension (office BP> or =140/90 mm Hg and ambulatory BP<130/80 mm Hg) (32.5% vs 24.2%, P<.001). Although office BP control (office BP<140/90 mm Hg, regardless of ambulatory values) was similar in women and men (22.3% vs 22.6%, P=.542), ambulatory BP control (ambulatory BP<130/80 mm Hg, regardless of office values) was higher in women than in men (48.9% vs 38.9%, P<.001). After adjustment for age, number of antihypertensive drugs, hypertension duration, and risk factors, gender differences in BP control remained practically unchanged. CONCLUSION Ambulatory BP control was higher in women than in men. This may be due to the higher frequency of isolated office hypertension in women, and it is not explained by gender differences in other important clinical characteristics.
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Affiliation(s)
- José R Banegas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, CIBER en Epidemiología y Salud Pública, Madrid, Spain.
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HORIKAWA T, OBARA T, OHKUBO T, ASAYAMA K, METOKI H, INOUE R, KIKUYA M, HASHIMOTO J, TOTSUNE K, IMAI Y. Difference between Home and Office Blood Pressures among Treated Hypertensive Patients from the Japan Home versus Office Blood Pressure Measurement Evaluation (J-HOME) Study. Hypertens Res 2008; 31:1115-23. [DOI: 10.1291/hypres.31.1115] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Mallion JM, Clerson P, Bobrie G, Genes N, Vaisse B, Chatellier G. Predictive factors for masked hypertension within a population of controlled hypertensives. J Hypertens 2007; 24:2365-70. [PMID: 17082717 DOI: 10.1097/01.hjh.0000251895.55249.82] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Prevalence of masked hypertension (MH) is far from negligible reaching 40% in some studies. The SHEAF study (Self measurement of blood pressure at Home in the Elderly: Assessment and Follow-Up) and others clearly showed that masked hypertension (MH) as detected by home blood pressure measurement (HBPM) is associated with poor cardiovascular prognosis. OBJECTIVE Systematic HBPM to detect MH is not yet routine. The aim of this work is to better define the clinical profile of masked hypertensives within a population with controlled office blood pressure (BP) and the factors associated with a higher prevalence of MH. MATERIALS AND METHODS BP was measured at the clinic by the doctor and at home by the patient himself. Risk factors for MH were analysed in a cohort of 1150 treated hypertensive patients over the age of 60 (mean age 70 +/- 6.5, 48.9% men) with controlled office BP. (SBP < 140 mmHg and DBP < 90 mmHg). RESULTS 463 patients (40%) were masked hypertensives (SBP > or = 135 mmHg or DBP > or = 85 mmHg at home). Three parameters were associated with MH (odds ratio OR): office SBP (OR = 1.110), male gender (OR = 2.214) and age (OR = 1.031). Decision trees showed a 130 mmHg SBP was an efficient threshold to propose HBPM with a higher probability to detect MH. Subsequent variables were male gender and age over 70 in males. CONCLUSION To detect masked hypertension, it would be logical to first of all select patients whose office SBP is between 130 and 140 mmHg.
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Affiliation(s)
- Jean-Michel Mallion
- Service de Cardiologie et hypertension artérielle, CHU, Grenoble, Roubaix, HEGP, Paris, France.
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Abstract
Masked hypertension (blood pressure that is normal in the physicians' office but elevated elsewhere) is a common phenomenon as prevalence among studies varies from 8 to 45% and is seen at all ages. large discrepancies, however, exist between studies that have dealt with masked hypertension. It is of high clinical importance as it is associated with higher target organ damage as compared with sustained normotension. Therefore more research should be determined. This paper provides an overview of current literature to improve knowledge about masked hypertension and about the cause of this phenomenon. In addition it provides some questions, which need to be answered for performing appropriate research into this subject in future.
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Affiliation(s)
- Willem J Verberk
- Department of Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands.
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Banegas JR, de la Sierra A, Segura J, Sobrino J, Ruilope LM. Response to Is Siesta Masking Masked Hypertension? Hypertension 2007. [DOI: 10.1161/01.hyp.0000258791.57165.bf] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- José R. Banegas
- Department of Preventive Medicine and Public Health, Autonomous University of Madrid, Madrid, Spain
| | | | - Julián Segura
- Hypertension Unit, Doce de Octubre Hospital, Madrid, Spain
| | - Javier Sobrino
- Hypertension Unit, Esperit Sant Hospital, Santa Coloma de Gramenet, Barcelona, Spain
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Banegas JR, Segura J, Sobrino J, Rodríguez-Artalejo F, de la Sierra A, de la Cruz JJ, Gorostidi M, Sarría A, Ruilope LM. Effectiveness of Blood Pressure Control Outside the Medical Setting. Hypertension 2007; 49:62-8. [PMID: 17075026 DOI: 10.1161/01.hyp.0000250557.63490.55] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We studied the effectiveness of blood pressure (BP) control outside the clinic by using ambulatory BP monitoring (ABPM) among a large number of hypertensive subjects treated in primary care centers across Spain. The sample consisted of 12 897 treated hypertensive subjects who had indications for ABPM. Office-based BP was calculated as the average of 2 readings. Twenty-four–hour ABPM was then performed using a SpaceLabs 90207 monitor under standardized conditions. A total of 3047 patients (23.6%) had their office BP controlled, and 6657 (51.6%) were controlled according to daytime ABPM. The proportion of office resistance or underestimation of patients’ BP control by physicians in the office (office BP ≥140/90 mm Hg and average daytime ambulatory BP <135/85 mm Hg) was 33.4%, and the proportion of isolated office control or overestimation of control (office BP <140/90 mm Hg and average daytime ambulatory BP ≥135/85 mm Hg) was 5.4%. BP control was more frequently underestimated in patients who were older, female, obese, or with morning BP determination than in their counterparts. BP control was more frequently overestimated in those who were younger, male, nonobese, smokers, or with evening BP determination. Ambulatory-based hypertension control was far better than office-based hypertension control. This conveys an encouraging message to clinicians, namely that they are actually doing better than is evidenced by office-based data. However, the burden of underestimation and overestimation of BP control at the office is still remarkable. Physicians should be aware that the likelihood of misestimating BP control is higher in some hypertensive subjects.
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Affiliation(s)
- José R Banegas
- Department of Preventive Medicine and Public Health, Autonomous University of Madrid, Madrid, Spain.
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Tomiyama M, Horio T, Kamide K, Nakamura S, Yoshihara F, Nakata H, Nakahama H, Kawano Y. Reverse white-coat effect as an independent risk for left ventricular concentric hypertrophy in patients with treated essential hypertension. J Hum Hypertens 2006; 21:212-9. [PMID: 17167525 DOI: 10.1038/sj.jhh.1002127] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Recent studies have shown that the converse phenomenon of white-coat hypertension called 'reverse white-coat hypertension' or 'masked hypertension' is associated with poor cardiovascular prognosis. We assessed the hypothesis that this phenomenon may specifically influence left ventricular (LV) structure in treated hypertensive patients. A total of 272 outpatients (mean age, 65 years) with chronically treated essential hypertension and without remarkable white-coat effect were enrolled. Patients were classified into two groups according to office and daytime ambulatory systolic blood pressure (SBP); that is subjects without (Group 1: office SBP > or =daytime SBP, n=149) and with reverse white-coat effect (Group 2: office SBP<daytime SBP, n=123). LV mass index and relative wall thickness were echocardiographically determined. In all subjects, LV mass index and relative wall thickness were positively correlated with daytime and 24-h SBP, but not with office SBP. In addition, these two indices were inversely correlated with office--daytime SBP difference. LV mass index (136+/-31 and 115+/-28 g/m(2), mean+/-s.d.) and relative wall thickness (0.49+/-0.09 and 0.46+/-0.07) were significantly greater in Group 2 than in Group 1. As for LV geometric patterns, Group 2 had a significantly higher rate of concentric hypertrophy compared with Group 1 (48 and 28%). Multivariate analyses revealed that the presence of reverse white-coat effect was a predictor for LV concentric hypertrophy, independent of age, sex, hypertension duration, antihypertensive treatment and ambulatory blood pressure levels. Our findings demonstrate that reverse white-coat effect is an independent risk factor for LV hypertrophy, especially concentric hypertrophy, in treated hypertensive patients.
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Affiliation(s)
- M Tomiyama
- Division of Hypertension and Nephrology, Department of Medicine, National Cardiovascular Center, Suita, Japan
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Abstract
A body of evidence indicates that masked hypertension is a significant predictor of cardiovascular disease, but how to identify these patients is still a matter of dispute. Data obtained in several cross-sectional studies have demonstrated that masked hypertension is associated with increased left ventricular mass index and carotid intima-media thickness, and impaired large artery distensibility. Furthermore, in longitudinal studies, masked hypertension was a strong predictor of cardiovascular morbidity and mortality. Several factors that can selectively raise ambulatory blood pressure increase the likelihood of having masked hypertension. These include younger age, smoking, alcohol use, contraceptive use in women, sedentary habits and central obesity. In addition, masked hypertension is more common in individuals with high-normal clinic blood pressure or transiently elevated blood pressure. Increased reactivity to daily life stressors and behavioural factors are other important predictors of masked hypertension. In clinical practice, masked hypertension should be searched for in individuals who are more likely to have this condition or are at increased risk of cardiovascular events including those with coronary, cerebrovascular or kidney disease, patients with diabetes and individuals with a high cardiovascular risk profile. To determine whether the use of ambulatory blood pressure monitoring is cost-effective in these individuals, further research is needed.
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Affiliation(s)
- Daniele Longo
- Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy
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25
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Abstract
Accurate diagnosis of hypertension and prognosis for future cardiovascular events can be enhanced through the use of 24-hour ambulatory blood pressure monitoring. It has been suggested that the use of ambulatory monitoring as a secondary screening for hypertension might be cost-effective. Many needed studies that are related to the calculation of cost-effectiveness for ambulatory monitoring have become available in recent years. More accurate estimates for cost of care, costs for testing, prevalence of white-coat hypertension, and incidence of the transition from normal pressures to hypertension have been reported. This study presents calculations of the cost savings likely to take place when ambulatory blood pressure monitoring is implemented for newly detected hypertensive subjects. These calculations are based on current estimates for cost of testing, cost of treatment, prevalence of white-coat hypertension at baseline, and varying the incidence of new hypertension after the initial screening. The results indicate a potential savings of 3% to 14% for cost of care for hypertension and 10% to 23% reduction in treatment days when ambulatory blood pressure monitoring is incorporated into the diagnostic process. At current reimbursement rates, the cost of ambulatory blood pressure monitoring for secondary screening on an annual basis would be <10% of treatment costs. Calculated savings for use of ambulatory blood pressure monitoring can take place when annual treatment costs are as little as $300. These estimates should be considered for the management of recently detected hypertension, especially when the risk of future cardiovascular is disease is low.
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Affiliation(s)
- Lawrence R Krakoff
- Mount Sinai School of Medicine, Englewood Hospital and Medical Center, Englewood, NJ 07631, USA.
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Abstract
Measurement of blood pressure (BP) by the own patient at home has become a popular procedure. Both a great offer of simple electronic devices and publication of multiple studies supporting its usefulness for the diagnosis and control of hypertension have contributed to this fact. In fact, this technique has various advantages over the conventional clinical measurement such as a higher reproducibility, better representation of the usual BP profile of the patient, greater correlation with target organs damage and greater morbimortality predictive value. Besides, there is a potential benefit on the control of patients under antihypertensives and, maybe, a reduction in health expenses at long-term follow-up. Currently, the main hypertension societies recommend the home measurement of BP in some clinical situations. However, it cannot be considered an alternative to the clinical measurement but rather a complementary technique in the evaluation of the hypertensive patient. Here we review the indications and limitations of this procedure in clinical practice.
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Affiliation(s)
- María Angeles Martínez-López
- Unidad de Hipertensión y Riesgo Vascular, Servicio de Medicina Interna, Hospital La Paz, Universidad Autónoma de Madrid, Madrid, Spain.
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Harada K, Karube Y, Saruhara H, Takeda K, Kuwajima I. Workplace Hypertension Is Associated with Obesity and Family History of Hypertension. Hypertens Res 2006; 29:969-76. [PMID: 17378369 DOI: 10.1291/hypres.29.969] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Job strain, which is a risk for hypertension and increased left ventricular mass, is thought to cause masked hypertension during work even if blood pressure (BP) is normal at health examinations. To study the prevalence of and factors related to workplace hypertension, 265 public officials (mean age, 41.4+/-10.7 years) measured their own BP at their workplace using semiautomated BP measurement devices. Factors related to workplace hypertension were assessed with multiple regression analysis. Workplace hypertension, defined as a BP no less than 140/90 mmHg, was observed in 23% of subjects (n=61). Compared with subjects without workplace hypertension (n=204), subjects with workplace hypertension were older (48.5+/-10.0 vs. 39.3+/-10.0 years), more likely to be men (69% vs. 46%), and had a higher body mass index (BMI) (23.4+/-2.7 vs. 21.6+/-3.2 kg/m(2)), higher cholesterol levels (214+/-33 vs. 194+/-36 mg/dl), and a higher Brinkman index (134+/-228 vs. 59+/-148). Subjects with workplace hypertension had higher BPs at checkup than did those without it (125+/-11/79+/-9 vs. 110+/-11/68+/-9 mmHg). The increases in BPs at the workplace were independently and significantly correlated with BMI, and a family history of hypertension. BP no less than 130/ 85 mmHg at health checkup was a good detector of workplace hypertension (sensitivity, 49%; specificity, 91%), suggesting that subjects with high-normal BPs at health checkup might have workplace hypertension. In conclusion, workplace hypertension was found to be associated with age, BMI, a family history of hypertension, and high-normal BPs at health checkup.
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Affiliation(s)
- Kazumasa Harada
- Division of Cardiology, Faculty of Medicine, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
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Manning G, Donnelly R. Use of home blood-pressure monitoring in the detection, treatment and surveillance of hypertension. Curr Opin Nephrol Hypertens 2005; 14:573-8. [PMID: 16205478 DOI: 10.1097/01.mnh.0000182531.02945.de] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Use of home blood-pressure monitoring is increasing but the technique and the equipment have limitations. We provide an overview of recent evidence in this rapidly evolving field. RECENT FINDINGS Home blood-pressure monitoring is an acceptable method for screening patients for hypertension. There is increasing evidence supporting the predictive power of home blood pressure for stroke risk even in the general population. The identification of white-coat and masked hypertension remains an important role for home blood-pressure monitoring. Unvalidated equipment and poor patient technique are major concerns. The purchase of devices needs to be linked to a simple patient-education programme, which is perhaps an opportunity for collaboration between healthcare providers and commercial companies. Devices that store the blood-pressure measurements in the memory are preferred to ensure accuracy of reporting. Data-transmission systems providing automatic storage, transmission and reporting of blood pressure, direct involvement of the patient and potentially a reduced number of hospital/general practitioner visits, offer significant advantages. To reduce patient anxiety, overuse of home blood-pressure monitoring should be avoided but there is the potential for self-modification of treatment, subject to certain safeguards. SUMMARY Self-monitoring of blood pressure is developing rapidly, linked to increasing awareness of the impact of reducing high blood pressure on public health and the marketing/advertising strategies used to sell automatic devices. Home blood-pressure monitoring has a role in the detection and management of blood pressure, but not at the expense of careful blood-pressure measurement in the office and adherence to national guidelines.
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Affiliation(s)
- Gillian Manning
- School of Medical & Surgical Sciences, University of Nottingham, Nottingham, and Derby Hospitals NHS Foundation Trust, Derby, UK.
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