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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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Swambulu TM, Mundedi YS, Nsimbi YL, Bompeka FL, Natuhoyila AN, Risasi JRM, Ilunga C, Kintoki Vita E, Kiese DK, Onembo NO, Minga RK, Madoda OT, M'buyamba-Kabangu JR, Phanzu BK. Masked uncontrolled hypertension among elderly black sub-saharan africans compared to younger adults: a cross-sectional in-hospital study. BMC Cardiovasc Disord 2024; 24:472. [PMID: 39232715 PMCID: PMC11373142 DOI: 10.1186/s12872-024-04150-0] [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: 01/29/2024] [Accepted: 08/29/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Although aging and being of African descent are well-known risk factors for masked uncontrolled hypertension (MUCH), data on MUCH among elderly black sub-Saharan Africans (BSSA) are limited. Furthermore, it is unclear whether the determinants of MUCH in younger individuals differ from those in the elderly. OBJECTIVE This study aimed to determine the prevalence and risk factors associated with MUCH in both elderly and younger BSSA individuals. METHODS In this study, 168 patients with treated hypertension were assessed for medical history, clinical examination, fundoscopy, echocardiography, and laboratory data. All patients underwent ambulatory blood pressure (BP) monitoring for 24 h. MUCH was diagnosed if the average 24-h mean BP ≥ 130/80 mmHg, the daytime mean BP ≥ 135/85 mmHg, and/or the nighttime mean BP ≥ 120/70 mmHg, despite controlled clinic BP (≤ 140/90 mmHg). Logistic regression analysis was performed to assess independent factors associated with MUCH, including elderly and younger adults separately. P-values < 0.05 were used to indicate statistical significance. RESULTS Of the 168 patients aged 53.6 ± 11.6 years, 92 (54.8%) were men, with a sex ratio of 1.2, and, 66 (39%) were aged ≥ 60 years. The proportion of patients with MUCH (27.4% for all patients) was significantly higher (p = 0.002) among elderly patients than among younger patients (45.5% vs. 15.7%). Diabetes mellitus (adjusted odds ratio [aOR], 2.44; 95% confidence interval [CI], 1.27-4.46; p = 0.043), anemia (aOR, 3.18; 95% CI, 1.07-5.81; p = 0.043), hypertensive retinopathy (aOR, 4.50; 95% CI, 1.57-5.4; p = 0.043), and left ventricular hypertrophy (aOR, 4.48; 95% CI, 2.26-8.35; p = 0.043) were independently associated with MUCH in the elderly. In younger individuals, male gender (aOR, 2.16; 95% CI, (1.33-4.80); p = 0.029), obesity (aOR, 3.02; 95% CI, (1.26-5.32); p = 0.001), and left ventricular hypertrophy (LVH) (aOR, 3.08; 95% CI, (2.14-6.24); p = 0.019) were independently associated with MUCH were independently associated with MUCH. CONCLUSION MUCH is more prevalent among elderly than among younger BSSA individuals. Determinants of MUCH vary by age. MUCH prevention and management strategies should be age-specific.
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Affiliation(s)
- Tresor Mvunzi Swambulu
- Cardiology Unit, University of Kinshasa, Kinshasa 1, PO Box 1038, Kinshasa, Democratic Republic of Congo
| | - Yannick Samafundu Mundedi
- Cardiology Unit, University of Kinshasa, Kinshasa 1, PO Box 1038, Kinshasa, Democratic Republic of Congo
| | - Yves Lubenga Nsimbi
- Cardiology Unit, University of Kinshasa, Kinshasa 1, PO Box 1038, Kinshasa, Democratic Republic of Congo
| | - François Lepira Bompeka
- Division of Nephrology, Department of Internal Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Aliocha Nkodila Natuhoyila
- Department of Family Medicine and Primary Health Care, Protestant University in the Congo, Kinshasa, Democratic Republic of Congo
| | - Jean-Robert Makulo Risasi
- Division of Nephrology, Department of Internal Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Cédric Ilunga
- Division of Nephrology, Department of Internal Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Eleuthère Kintoki Vita
- Cardiology Unit, University of Kinshasa, Kinshasa 1, PO Box 1038, Kinshasa, Democratic Republic of Congo
| | - Diane Kuntonda Kiese
- Cardiology Unit, University of Kinshasa, Kinshasa 1, PO Box 1038, Kinshasa, Democratic Republic of Congo
| | - Noel Otshudi Onembo
- Cardiology Unit, University of Kinshasa, Kinshasa 1, PO Box 1038, Kinshasa, Democratic Republic of Congo
| | - Roger Kongo Minga
- Unit of cardiology, Clinique Ngaliema, Kinshasa, Democratic Republic of Congo
| | | | | | - Bernard Kianu Phanzu
- Cardiology Unit, University of Kinshasa, Kinshasa 1, PO Box 1038, Kinshasa, Democratic Republic of Congo.
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Miranda RD, Brandão AA, Barroso WKS, Mota-Gomes MA, Barbosa ECD, Ribeiro LP, Aguilar CA, Silveira FS, Gomes CDMR, Epelman A, de Paiva AMG, Feitosa ADM. National Registry of Hypertension Control Evaluated by Office and Home Measurements: The LHAR National Registry. Arq Bras Cardiol 2023; 120:e20220863. [PMID: 37586005 PMCID: PMC10464860 DOI: 10.36660/abc.20220863] [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: 11/27/2022] [Revised: 04/23/2023] [Accepted: 05/17/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND It is known that around 30% of patients have higher blood pressure (BP) values when examined at the office than at home. Worldwide, only 35% of patients with hypertension undergoing treatment have reached their BP targets. OBJECTIVE To provide epidemiological data on BP control in the offices of a sample of Brazilian cardiologists, considering office and home BP measurement. METHODS This is a cross-sectional analysis of patients with a hypertension diagnosis and undergoing antihypertensive treatment, with controlled BP or not. BP was assayed in the office by a medical professional and at home using home BP monitoring (HBPM). The association between categorical variables was verified using the chi-square test (p<0.05). RESULTS The study included 2540 patients, with a mean age of 59.7 ± 15.2 years. Most patients were women (62%; n=1575). Prevalence rates of 15% (n=382) for uncontrolled white coat hypertension and 10% (n=253) for uncontrolled masked hypertension were observed. The rate of BP control in the office was 56.3% and at home, 61%. Meanwhile, 46.4% of the patients had controlled BP in and outside of the office. Greater control was observed in women and in the 49-61 years age group. Considering the new DBHA 2020 threshold for home BP control, the control rate was 42.4%. CONCLUSION BP control in the offices of a sample of Brazilian cardiologists was 56.3%; this rate was 61% when BP was measured at home and 46.4% when considering both the office and home.
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Affiliation(s)
- Roberto Dischinger Miranda
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrasilServiço de Cardiologia, Disciplina de Geriatria e Gerontologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Andréa Araujo Brandão
- Universidade do Estado do Rio de JaneiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ – Brasil
| | - Weimar Kunz Sebba Barroso
- Liga de Hipertensão ArterialHospital das ClínicasUniversidade Federal de GoiásGoiâniaGOBrasilLiga de Hipertensão Arterial - Hospital das Clínicas - Universidade Federal de Goiás, Goiânia, GO – Brasil
| | - Marco Antonio Mota-Gomes
- Centro Universitário CESMACHospital do CoraçãoMaceióALBrasil Centro Universitário CESMAC, Hospital do Coração, Maceió, AL – Brasil
| | - Eduardo Costa Duarte Barbosa
- Liga de Combate à Hipertensão ArterialPorto AlegreRSBrasil Liga de Combate à Hipertensão Arterial, Porto Alegre, RS – Brasil
| | | | | | - Fabio Serra Silveira
- Centro de PesquisaClínica do CoraçãoAracajuSEBrasilCentro de Pesquisa Clínica do Coração, Aracaju, SE – Brasil
| | | | - Abraham Epelman
- Servier do BrasilRio de JaneiroRJBrasilServier do Brasil, Rio de Janeiro, RJ – Brasil
| | - Annelise Machado Gomes de Paiva
- Centro Universitário CESMACHospital do CoraçãoMaceióALBrasil Centro Universitário CESMAC, Hospital do Coração, Maceió, AL – Brasil
| | - Audes Diógenes Magalhães Feitosa
- Unidade de Hipertensão e Cardiologia PreventivaPROCAPEUniversidade de PernambucoRecifePEBrasilUnidade de Hipertensão e Cardiologia Preventiva do PROCAPE, Universidade de Pernambuco, Recife, PE – Brasil
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4
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Hypertension Canada's 2020 Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children. Can J Cardiol 2021; 36:596-624. [PMID: 32389335 DOI: 10.1016/j.cjca.2020.02.086] [Citation(s) in RCA: 272] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 02/23/2020] [Accepted: 02/23/2020] [Indexed: 11/21/2022] Open
Abstract
Hypertension Canada's 2020 guidelines for the prevention, diagnosis, risk assessment, and treatment of hypertension in adults and children provide comprehensive, evidence-based guidance for health care professionals and patients. Hypertension Canada develops the guidelines using rigourous methodology, carefully mitigating the risk of bias in our process. All draft recommendations undergo critical review by expert methodologists without conflict to ensure quality. Our guideline panel is diverse, including multiple health professional groups (nurses, pharmacy, academics, and physicians), and worked in concert with experts in primary care and implementation to ensure optimal usability. The 2020 guidelines include new guidance on the management of resistant hypertension and the management of hypertension in women planning pregnancy.
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5
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Masked Hypertension: A Systematic Review. Heart Lung Circ 2020; 29:102-111. [DOI: 10.1016/j.hlc.2019.08.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 06/15/2019] [Accepted: 08/04/2019] [Indexed: 12/22/2022]
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 138:e484-e594. [PMID: 30354654 DOI: 10.1161/cir.0000000000000596] [Citation(s) in RCA: 220] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Paul K Whelton
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Robert M Carey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Wilbert S Aronow
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Donald E Casey
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Karen J Collins
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Cheryl Dennison Himmelfarb
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sondra M DePalma
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Samuel Gidding
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kenneth A Jamerson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Daniel W Jones
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Eric J MacLaughlin
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Paul Muntner
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Bruce Ovbiagele
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sidney C Smith
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Crystal C Spencer
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randall S Stafford
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Sandra J Taler
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Randal J Thomas
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Kim A Williams
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jeff D Williamson
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
| | - Jackson T Wright
- American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative
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7
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Gluskin E, Tzukert K, Mor-Yosef Levi I, Gotsman O, Sagiv I, Abel R, Bloch A, Rubinger D, Aharon M, Dranitzki Elhalel M, Ben-Dov IZ. Ambulatory monitoring unmasks hypertension among kidney transplant patients: single center experience and review of the literature. BMC Nephrol 2019; 20:284. [PMID: 31351470 PMCID: PMC6661097 DOI: 10.1186/s12882-019-1442-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/27/2019] [Indexed: 12/13/2022] Open
Abstract
Background Disagreements between clinic and ambulatory blood pressure (BP) measurements are well-described in the general population. Though hypertension is frequent in renal transplant recipients, only a few studies address the clinic-ambulatory discordance in this population. We aimed to describe the difference between clinic and ambulatory BP in kidney transplant patients at our institution. Methods We compared the clinic and ambulatory BP of 76 adult recipients of a kidney allograft followed at our transplant center and investigated the difference between these methods, considering confounding by demographic and clinical variables. Results Clinic systolic BP (SBP) and diastolic BP (DBP) were 128 ± 13/79 ± 9 mmHg. Awake SBP and DBP were 147 ± 18/85 ± 10 mmHg. The clinic-minus-awake SBP and DBP differences were − 18 and − 6 mmHg, respectively. The negative clinic-awake ΔSBP was more pronounced at age > 60 years (p = 0.026) and with tacrolimus use compared to cyclosporine (p = 0.046). Sleep SBP and DBP were 139 ± 21/78 ± 11 mmHg. A non-dipping sleep BP pattern was noted in 73% of patients and was associated with tacrolimus use (p = 0.020). Conclusions Our findings suggest pervasive underestimation of BP when measured in the kidney transplant clinic, emphasizes the high frequency of a non-dipping pattern in this population and calls for liberal use of ambulatory BP monitoring to detect and manage hypertension. Electronic supplementary material The online version of this article (10.1186/s12882-019-1442-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eitan Gluskin
- Department of Nephrology and Hypertension, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Keren Tzukert
- Department of Nephrology and Hypertension, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Irit Mor-Yosef Levi
- Department of Nephrology and Hypertension, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Olga Gotsman
- Department of Nephrology and Hypertension, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Itamar Sagiv
- Department of Nephrology and Hypertension, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Roy Abel
- Department of Nephrology and Hypertension, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Aharon Bloch
- Department of Nephrology and Hypertension, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Dvorah Rubinger
- Department of Nephrology and Hypertension, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Michal Aharon
- Department of Nephrology and Hypertension, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Michal Dranitzki Elhalel
- Department of Nephrology and Hypertension, Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Iddo Z Ben-Dov
- Department of Nephrology and Hypertension, Hadassah - Hebrew University Medical Center, Jerusalem, Israel.
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Cuspidi C, Sala C, Tadic M, Grassi G. When Office Blood Pressure Is Not Enough: The Case of Masked Hypertension. Am J Hypertens 2019; 32:225-233. [PMID: 30508171 DOI: 10.1093/ajh/hpy183] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/30/2018] [Indexed: 01/04/2023] Open
Abstract
An increasing attention has been devoted in the last two decades to masked hypertension (MH), a condition characterized by the fact that classification of a normal blood pressure (BP) status by office measurements is not confirmed by home and/or ambulatory BP monitoring (ABPM). MH definition (i.e., normal office BP, but high out-of-office BP) should be restricted to untreated subjects (true MH) whereas masked uncontrolled hypertension (MUCH) reserved to treated patients previously classified as hypertensives, presenting normal office BP and high ABPM or home values. Both MH and MUCH are associated with metabolic alterations, comorbidities, and hypertension-mediated organ damage (HMOD). Furthermore, the risk of cardiovascular events related to these conditions has been shown to be close or greater than that of sustained hypertension. This review discusses available evidence about MH and MUCH by focusing on its prevalence, clinical correlates, association with HMOD, prognostic significance, and their therapeutic implications.
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Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
- Istituto Auxologico Italiano IRCCS, Milano, Italy
| | - Carla Sala
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione IRCCS Ospedale Maggiore Policlinico, Milano, Italy
| | - Marijana Tadic
- Department of Cardiology, Charité-University-Medicine Campus Virchow Klinikum, Berlin, Germany
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
- IRCCS Multimedica, Sesto San Giovanni, Milano, Italy
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9
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018. [DOI: 10.1161/hyp.0000000000000065 10.1016/j.jacc.2017.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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10
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Could self-measured office blood pressure be a hypertension screening tool for limited-resources settings? J Hum Hypertens 2018; 32:415-422. [PMID: 29713048 DOI: 10.1038/s41371-018-0057-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 01/24/2018] [Accepted: 02/19/2018] [Indexed: 11/09/2022]
Abstract
Blood pressure (BP) was assessed by patients themselves in recently published trials. Self-measured office blood pressure (SMOBP) seems particularly interesting for limited health resources regions. The aim of our study was to evaluate the relationship between SMOBP values and those estimated by ambulatory blood pressure monitoring (ABPM). Six hundred seventy-seven patients were evaluated using both, SMOBP and ABPM. The differences between SMOBP and daytime ABPM were evaluated with paired "t" test. The correlations among SMOBP and ABPM were estimated using Pearson's r. The accuracy of SMOBP to identify abnormal ABPM was determined using area under ROC curve (AUC). Sensitivity, specificity, and positive and negative predictive values were calculated for different SMOBP cut-points. Using the average of three readings, systolic SMOBP was higher (3.7 (14.2) mmHg, p < 0.001) and diastolic SMOBP lower (1.5 (8.1) mmHg, p < 0.001) than ABPM. Both BP estimates had a significant correlation, r = 0.67 and r = 0.75 (p < 0.01) for systolic and diastolic BP, respectively. Systolic SMOBP predicted systolic abnormal ABPM; the AUC were 0.80 (0.77-0.84) and 0.78 (0.74-0.81) for daytime and 24 h hypertension, respectively. Diastolic SMOBP predicted diastolic hypertension, AUC 0.86 (0.83-0.88) for both daytime and 24 h hypertension. Neither correlations nor AUCs improved significantly using the average of five readings. SMOBP ≥ 160/90 mmHg was highly specific (>95%) to identify individuals with hypertension in the ABPM; SMOBP < 130/80 mmHg reasonably discarded abnormal ABPM. In conclusion, a high proportion of individuals could be classified adequately using SMOBP, reducing the necessity of healthcare resources and supporting its utility for screening purposes.
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Naser N, Dzubur A, Durak A, Kulic M, Naser N. Blood Pressure Control in Hypertensive Patients, Cardiovascular Risk Profile and the Prevalence of Masked Uncontrolled Hypertension (MUCH). Med Arch 2018; 70:274-279. [PMID: 27703288 PMCID: PMC5034977 DOI: 10.5455/medarh.2016.70.274-279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 06/25/2016] [Indexed: 11/16/2022] Open
Abstract
Introduction: The term masked hypertension (MH) should be used for untreated individuals who have normal office blood pressure but elevated ambulatory blood pressure. For treated patients, this condition should be termed masked uncontrolled hypertension (MUCH). Research Objectives: Masked uncontrolled hypertension (MUCH) has gone unrecognized because few studies have used 24-h ABPM to determine the prevalence of suboptimal BP control in seemingly well-treated patients, and there are few such studies in large cohorts of treated patients attending usual clinical practice. This is important because masked hypertension is associated with a high risk of cardiovascular events. This study was conducted to obtain more information about the association between hypertension and other CV risk factors, about office and ambulatory blood pressure (BP) control as well as on cardiovascular (CV) risk profile in treated hypertensive patients, also to define the prevalence and characteristics of masked uncontrolled hypertension (MUCH) among treated hypertensive patients in routine clinical practice. Patients and methods: In this study 2514 male and female patients were included during a period of 5 years follow up. All patients have ambulatory blood pressure monitoring (ABPM) for at least 24h. We identified patients with treated and controlled BP according to current international guidelines (clinic BP, 140/90mmHg). Cardiovascular risk assessment was based on personal history, clinic BP values, as well as target organ damage evaluation. Masked uncontrolled hypertension (MUCH) was diagnosed in these patients if despite controlled clinic BP, the mean 24-h ABPM average remained elevated (24-h systolic BP ≥130mmHg and/or 24-h diastolic BP ≥80mmHg). Results: Patients had a mean age of 60.2+10 years, and the majority of them (94.6%) were followed by specialist physicians. Average clinic BP was 150.4+16/89.9+12 mmHg. About 70% of patients displayed a very high-risk profile. Ambulatory blood pressure monitoring (ABPM) was performed in all recruited patients for at least 24h. Despite the combined medical treatment (78% of the patients), clinic control (<140/90 mmHg) was achieved in only 26.2% of patients, the corresponding control rate for ambulatory BP (<130/80 mmHg) being 32.7%. From 2514 patients with treated BP, we identified 803 with treated and controlled office BP control (<140/90 mmHg), of whom 258 patients (32.1%) had MUCH according to 24-h ABPM criteria (mean age 57.2 years, 54.7% men). The prevalence of MUCH was slightly higher in males, patients with borderline clinic and office BP (130–139/80–89 mmHg), and patients at high cardiovascular risk (smokers, diabetes, obesity). Masked uncontrolled hypertension (MUCH) was most often due to poor control of nocturnal BP, with the proportion of patients in whom MUCH was solely attributable to an elevated nocturnal BP almost double that solely attributable to daytime BP elevation (22.3 vs. 10.1%, P 0.001). Conclusion: The prevalence of masked suboptimal BP control in patients with treated and well-controlled clinic BP is high. The characteristics of patients with MUCH (male, longer duration of hypertension, obesity, smoking history, and diabetes) indicate that this is a higher-risk group with most to gain from improved BP.
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Affiliation(s)
- Nabil Naser
- Polyclinic "Dr. Nabil", Sarajevo, Bosnia and Herzegovina
| | - Alen Dzubur
- Institute for heart diseases, University Clinical Center Sarajevo, Bosnia and Herzegovina
| | - Azra Durak
- Institute for heart diseases, University Clinical Center Sarajevo, Bosnia and Herzegovina
| | - Mehmed Kulic
- Institute for heart diseases, University Clinical Center Sarajevo, Bosnia and Herzegovina
| | - Nura Naser
- Polyclinic "Dr. Nabil", Sarajevo, Bosnia and Herzegovina
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Affiliation(s)
- Wilbert S Aronow
- Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
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13
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2017; 71:e13-e115. [PMID: 29133356 DOI: 10.1161/hyp.0000000000000065] [Citation(s) in RCA: 1577] [Impact Index Per Article: 225.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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14
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Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017; 71:e127-e248. [PMID: 29146535 DOI: 10.1016/j.jacc.2017.11.006] [Citation(s) in RCA: 3113] [Impact Index Per Article: 444.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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15
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Masked hypertension, rather than white-coat hypertension, has a prognostic role in patients with non-dialysis chronic kidney disease. Int J Cardiol 2017; 230:33-39. [DOI: 10.1016/j.ijcard.2016.12.105] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/29/2016] [Accepted: 12/17/2016] [Indexed: 11/22/2022]
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16
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Al Hamarneh YN, Houle SKD, Padwal R, Tsuyuki RT. Hypertension Canada's 2016 Canadian Hypertension Education Program guidelines for pharmacists: An update. Can Pharm J (Ott) 2016; 149:337-344. [PMID: 27829857 DOI: 10.1177/1715163516671747] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Yazid N Al Hamarneh
- EPICORE Centre/COMPRIS (Al Hamarneh, Tsuyuki) and the Department of Medicine (Al Hamarneh, Tsuyuki), University of Alberta, Edmonton, Alberta; and the University of Waterloo School of Pharmacy (Houle), Kitchener, Ontario
| | - Sherilyn K D Houle
- EPICORE Centre/COMPRIS (Al Hamarneh, Tsuyuki) and the Department of Medicine (Al Hamarneh, Tsuyuki), University of Alberta, Edmonton, Alberta; and the University of Waterloo School of Pharmacy (Houle), Kitchener, Ontario
| | - Raj Padwal
- EPICORE Centre/COMPRIS (Al Hamarneh, Tsuyuki) and the Department of Medicine (Al Hamarneh, Tsuyuki), University of Alberta, Edmonton, Alberta; and the University of Waterloo School of Pharmacy (Houle), Kitchener, Ontario
| | - Ross T Tsuyuki
- EPICORE Centre/COMPRIS (Al Hamarneh, Tsuyuki) and the Department of Medicine (Al Hamarneh, Tsuyuki), University of Alberta, Edmonton, Alberta; and the University of Waterloo School of Pharmacy (Houle), Kitchener, Ontario
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17
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Tang H, Gong WY, Zhang QZ, Zhang J, Ye ZC, Peng H, Wang C, Lou T. Prevalence, determinants, and clinical significance of masked hypertension and white-coat hypertension in patients with chronic kidney disease. Nephrology (Carlton) 2016; 21:841-50. [PMID: 26566951 DOI: 10.1111/nep.12672] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 10/31/2015] [Accepted: 11/09/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Hua Tang
- Division of Nephrology, Department of Medicine; Third Affiliated Hospital of Sun Yat-Sen University; Guangzhou Guangdong 510630 China
| | - Wen-Yu Gong
- Division of Nephrology, Department of Medicine; the First Affiliated Hospital of JiNan University; Guangzhou Guangdong 510630 China
| | - Qun-Zi Zhang
- Division of Nephrology, Department of Medicine; Third Affiliated Hospital of Sun Yat-Sen University; Guangzhou Guangdong 510630 China
| | - Jun Zhang
- Division of Nephrology, Department of Medicine; Third Affiliated Hospital of Sun Yat-Sen University; Guangzhou Guangdong 510630 China
| | - Zeng-Chun Ye
- Division of Nephrology, Department of Medicine; Third Affiliated Hospital of Sun Yat-Sen University; Guangzhou Guangdong 510630 China
| | - Hui Peng
- Division of Nephrology, Department of Medicine; Third Affiliated Hospital of Sun Yat-Sen University; Guangzhou Guangdong 510630 China
| | - Cheng Wang
- Division of Nephrology, Department of Medicine; Third Affiliated Hospital of Sun Yat-Sen University; Guangzhou Guangdong 510630 China
| | - Tanqi Lou
- Division of Nephrology, Department of Medicine; Third Affiliated Hospital of Sun Yat-Sen University; Guangzhou Guangdong 510630 China
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18
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Sheppard JP, Stevens R, Gill P, Martin U, Godwin M, Hanley J, Heneghan C, Hobbs FDR, Mant J, McKinstry B, Myers M, Nunan D, Ward A, Williams B, McManus RJ. Predicting Out-of-Office Blood Pressure in the Clinic (PROOF-BP): Derivation and Validation of a Tool to Improve the Accuracy of Blood Pressure Measurement in Clinical Practice. Hypertension 2016; 67:941-50. [PMID: 27001299 PMCID: PMC4905620 DOI: 10.1161/hypertensionaha.115.07108] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 02/03/2016] [Indexed: 11/16/2022]
Abstract
Patients often have lower (white coat effect) or higher (masked effect) ambulatory/home blood pressure readings compared with clinic measurements, resulting in misdiagnosis of hypertension. The present study assessed whether blood pressure and patient characteristics from a single clinic visit can accurately predict the difference between ambulatory/home and clinic blood pressure readings (the home-clinic difference). A linear regression model predicting the home-clinic blood pressure difference was derived in 2 data sets measuring automated clinic and ambulatory/home blood pressure (n=991) using candidate predictors identified from a literature review. The model was validated in 4 further data sets (n=1172) using area under the receiver operator characteristic curve analysis. A masked effect was associated with male sex, a positive clinic blood pressure change (difference between consecutive measurements during a single visit), and a diagnosis of hypertension. Increasing age, clinic blood pressure level, and pulse pressure were associated with a white coat effect. The model showed good calibration across data sets (Pearson correlation, 0.48-0.80) and performed well-predicting ambulatory hypertension (area under the receiver operator characteristic curve, 0.75; 95% confidence interval, 0.72-0.79 [systolic]; 0.87; 0.85-0.89 [diastolic]). Used as a triaging tool for ambulatory monitoring, the model improved classification of a patient's blood pressure status compared with other guideline recommended approaches (93% [92% to 95%] classified correctly; United States, 73% [70% to 75%]; Canada, 74% [71% to 77%]; United Kingdom, 78% [76% to 81%]). This study demonstrates that patient characteristics from a single clinic visit can accurately predict a patient's ambulatory blood pressure. Usage of this prediction tool for triaging of ambulatory monitoring could result in more accurate diagnosis of hypertension and hence more appropriate treatment.
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Affiliation(s)
- James P Sheppard
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (J.P.S., R.S., C.H., F.D.R.H., D.N., A.W., R.J.M.); Institute of Applied Health Research, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom (P.G., U.M.); Family Practice Unit, Memorial University of Newfoundland, St John's, Newfoundland, NL, Canada (M.G.); Health Services Research Unit, Edinburgh Napier University, Edinburgh, United Kingdom (J.H.); Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom (J.M.); Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (B.M.); Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (M.M.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (B.W.).
| | - Richard Stevens
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (J.P.S., R.S., C.H., F.D.R.H., D.N., A.W., R.J.M.); Institute of Applied Health Research, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom (P.G., U.M.); Family Practice Unit, Memorial University of Newfoundland, St John's, Newfoundland, NL, Canada (M.G.); Health Services Research Unit, Edinburgh Napier University, Edinburgh, United Kingdom (J.H.); Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom (J.M.); Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (B.M.); Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (M.M.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (B.W.)
| | - Paramjit Gill
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (J.P.S., R.S., C.H., F.D.R.H., D.N., A.W., R.J.M.); Institute of Applied Health Research, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom (P.G., U.M.); Family Practice Unit, Memorial University of Newfoundland, St John's, Newfoundland, NL, Canada (M.G.); Health Services Research Unit, Edinburgh Napier University, Edinburgh, United Kingdom (J.H.); Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom (J.M.); Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (B.M.); Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (M.M.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (B.W.)
| | - Una Martin
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (J.P.S., R.S., C.H., F.D.R.H., D.N., A.W., R.J.M.); Institute of Applied Health Research, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom (P.G., U.M.); Family Practice Unit, Memorial University of Newfoundland, St John's, Newfoundland, NL, Canada (M.G.); Health Services Research Unit, Edinburgh Napier University, Edinburgh, United Kingdom (J.H.); Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom (J.M.); Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (B.M.); Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (M.M.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (B.W.)
| | - Marshall Godwin
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (J.P.S., R.S., C.H., F.D.R.H., D.N., A.W., R.J.M.); Institute of Applied Health Research, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom (P.G., U.M.); Family Practice Unit, Memorial University of Newfoundland, St John's, Newfoundland, NL, Canada (M.G.); Health Services Research Unit, Edinburgh Napier University, Edinburgh, United Kingdom (J.H.); Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom (J.M.); Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (B.M.); Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (M.M.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (B.W.)
| | - Janet Hanley
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (J.P.S., R.S., C.H., F.D.R.H., D.N., A.W., R.J.M.); Institute of Applied Health Research, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom (P.G., U.M.); Family Practice Unit, Memorial University of Newfoundland, St John's, Newfoundland, NL, Canada (M.G.); Health Services Research Unit, Edinburgh Napier University, Edinburgh, United Kingdom (J.H.); Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom (J.M.); Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (B.M.); Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (M.M.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (B.W.)
| | - Carl Heneghan
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (J.P.S., R.S., C.H., F.D.R.H., D.N., A.W., R.J.M.); Institute of Applied Health Research, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom (P.G., U.M.); Family Practice Unit, Memorial University of Newfoundland, St John's, Newfoundland, NL, Canada (M.G.); Health Services Research Unit, Edinburgh Napier University, Edinburgh, United Kingdom (J.H.); Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom (J.M.); Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (B.M.); Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (M.M.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (B.W.)
| | - F D Richard Hobbs
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (J.P.S., R.S., C.H., F.D.R.H., D.N., A.W., R.J.M.); Institute of Applied Health Research, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom (P.G., U.M.); Family Practice Unit, Memorial University of Newfoundland, St John's, Newfoundland, NL, Canada (M.G.); Health Services Research Unit, Edinburgh Napier University, Edinburgh, United Kingdom (J.H.); Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom (J.M.); Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (B.M.); Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (M.M.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (B.W.)
| | - Jonathan Mant
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (J.P.S., R.S., C.H., F.D.R.H., D.N., A.W., R.J.M.); Institute of Applied Health Research, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom (P.G., U.M.); Family Practice Unit, Memorial University of Newfoundland, St John's, Newfoundland, NL, Canada (M.G.); Health Services Research Unit, Edinburgh Napier University, Edinburgh, United Kingdom (J.H.); Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom (J.M.); Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (B.M.); Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (M.M.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (B.W.)
| | - Brian McKinstry
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (J.P.S., R.S., C.H., F.D.R.H., D.N., A.W., R.J.M.); Institute of Applied Health Research, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom (P.G., U.M.); Family Practice Unit, Memorial University of Newfoundland, St John's, Newfoundland, NL, Canada (M.G.); Health Services Research Unit, Edinburgh Napier University, Edinburgh, United Kingdom (J.H.); Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom (J.M.); Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (B.M.); Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (M.M.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (B.W.)
| | - Martin Myers
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (J.P.S., R.S., C.H., F.D.R.H., D.N., A.W., R.J.M.); Institute of Applied Health Research, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom (P.G., U.M.); Family Practice Unit, Memorial University of Newfoundland, St John's, Newfoundland, NL, Canada (M.G.); Health Services Research Unit, Edinburgh Napier University, Edinburgh, United Kingdom (J.H.); Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom (J.M.); Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (B.M.); Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (M.M.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (B.W.)
| | - David Nunan
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (J.P.S., R.S., C.H., F.D.R.H., D.N., A.W., R.J.M.); Institute of Applied Health Research, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom (P.G., U.M.); Family Practice Unit, Memorial University of Newfoundland, St John's, Newfoundland, NL, Canada (M.G.); Health Services Research Unit, Edinburgh Napier University, Edinburgh, United Kingdom (J.H.); Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom (J.M.); Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (B.M.); Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (M.M.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (B.W.)
| | - Alison Ward
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (J.P.S., R.S., C.H., F.D.R.H., D.N., A.W., R.J.M.); Institute of Applied Health Research, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom (P.G., U.M.); Family Practice Unit, Memorial University of Newfoundland, St John's, Newfoundland, NL, Canada (M.G.); Health Services Research Unit, Edinburgh Napier University, Edinburgh, United Kingdom (J.H.); Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom (J.M.); Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (B.M.); Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (M.M.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (B.W.)
| | - Bryan Williams
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (J.P.S., R.S., C.H., F.D.R.H., D.N., A.W., R.J.M.); Institute of Applied Health Research, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom (P.G., U.M.); Family Practice Unit, Memorial University of Newfoundland, St John's, Newfoundland, NL, Canada (M.G.); Health Services Research Unit, Edinburgh Napier University, Edinburgh, United Kingdom (J.H.); Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom (J.M.); Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (B.M.); Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (M.M.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (B.W.)
| | - Richard J McManus
- From the Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom (J.P.S., R.S., C.H., F.D.R.H., D.N., A.W., R.J.M.); Institute of Applied Health Research, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom (P.G., U.M.); Family Practice Unit, Memorial University of Newfoundland, St John's, Newfoundland, NL, Canada (M.G.); Health Services Research Unit, Edinburgh Napier University, Edinburgh, United Kingdom (J.H.); Cambridge Institute of Public Health, University of Cambridge, Cambridge, United Kingdom (J.M.); Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom (B.M.); Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (M.M.); and Institute of Cardiovascular Science, University College London, London, United Kingdom (B.W.)
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Prevalence of masked uncontrolled hypertension according to the number of office blood pressure measurements. Rev Clin Esp 2015; 215:425-30. [DOI: 10.1016/j.rce.2015.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/20/2015] [Accepted: 06/17/2015] [Indexed: 11/18/2022]
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Prevalence of masked uncontrolled hypertension according to the number of office blood pressure measurements. Rev Clin Esp 2015. [DOI: 10.1016/j.rceng.2015.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Houle SKD, Padwal R, Poirier L, Tsuyuki RT. The 2015 Canadian Hypertension Education Program (CHEP) guidelines for pharmacists: An update. Can Pharm J (Ott) 2015; 148:180-6. [PMID: 26448770 DOI: 10.1177/1715163515586847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Raj Padwal
- University of Waterloo School of Pharmacy (Houle), Kitchener, Ontario
| | - Luc Poirier
- University of Waterloo School of Pharmacy (Houle), Kitchener, Ontario
| | - Ross T Tsuyuki
- University of Waterloo School of Pharmacy (Houle), Kitchener, Ontario
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Petrella RJ, Gill DP, Berrou JP. Effect of eprosartan-based antihypertensive therapy on coronary heart disease risk assessed by Framingham methodology in Canadian patients with diabetes: results of the POWER survey. Diabetes Metab Syndr Obes 2015; 8:173-80. [PMID: 25848310 PMCID: PMC4376186 DOI: 10.2147/dmso.s79221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE As part of the Physicians' Observational Work on Patient Education According to their Vascular Risk (POWER) survey, we used Framingham methodology to examine the effect of an eprosartan-based regimen on total coronary heart disease (CHD) risk in diabetic patients recruited in Canada. METHODS Patients with new or uncontrolled hypertension (sitting systolic blood pressure [SBP] >140 mmHg with diastolic blood pressure <110 mmHg) were identified at 335 Canadian primary care practices. Initial treatment consisted of eprosartan 600 mg/day, which was later supplemented with other antihypertensives as required. Outcomes included change in SBP at 6 months (primary objective) and absolute change in the Framingham 10-year CHD risk score (secondary objective). RESULTS We identified an intention-to-treat diabetes population of 195 patients. Most diabetic patients were prescribed two or more antihypertensive drugs throughout the survey. Mean reductions in SBP and diastolic blood pressure were 20.8±14.8 mmHg and 9.5±10.7 mmHg, respectively. The overall absolute mean 10-year CHD risk, calculated using Framingham formulae, declined by 2.9±3.5 points (n=49). Average baseline risk was higher in men than women (14.8±8.6 versus 5.6±1.8 points); men also had a larger average risk reduction (4.2±4.3 versus 1.5±1.3 points). The extent of absolute risk reduction also increased with increasing age (trend not statistically significant). CONCLUSION Eprosartan-based therapy substantially reduced arterial blood pressure in our subset of diabetic patients; while there was a slight reduction in Framingham risk, there are indications from our data that both blood pressure control and the wider management of CHD risk in diabetic patients remains suboptimal in Canadian primary care.
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Affiliation(s)
- Robert J Petrella
- Departments of Family Medicine, Medicine (Cardiology) and Kinesiology, University of Western Ontario, London, ON, Canada
- Aging, Rehabilitation and Geriatric Care Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Family Medicine and School of Health Studies, University of Western Ontario, London, ON, Canada
- Correspondence: Robert J Petrella, Aging, Rehabilitation and Geriatric Care Research Centre, St Joseph’s Parkwood Hospital, 801 Commissioners Road E, Suite B3002, London, ON, N6C 5J1, Canada, Tel +1 519 685 4292 ext 42983, Fax +1 519 685 4071, Email
| | - Dawn P Gill
- Aging, Rehabilitation and Geriatric Care Research Centre, Lawson Health Research Institute, London, ON, Canada
- Department of Family Medicine and School of Health Studies, University of Western Ontario, London, ON, Canada
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Banegas JR, Ruilope LM, de la Sierra A, de la Cruz JJ, Gorostidi M, Segura J, Martell N, Garcia-Puig J, Deanfield J, Williams B. High prevalence of masked uncontrolled hypertension in people with treated hypertension. Eur Heart J 2014; 35:3304-12. [DOI: 10.1093/eurheartj/ehu016] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Afsar B. The impact of different anthropometric measures on sustained normotension, white coat hypertension, masked hypertension, and sustained hypertension in patients with type 2 diabetes. Endocrinol Metab (Seoul) 2013; 28:199-206. [PMID: 24396679 PMCID: PMC3811700 DOI: 10.3803/enm.2013.28.3.199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 06/27/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many studies have aimed to determine whether body mass index (BMI), waist circumference (WC), or waist to hip ratio (WHR) best predicts hypertension in diabetic patients, with conflicting results. However, no study has examined the specific relationship between these anthropometric parameters with sustained normotension (SNT), white coat hypertension (WCHT), masked hypertension (MHT), and sustained hypertension (SHT) based on office and ambulatory blood pressure (BP) measurements in these patients. METHODS Patients with newly diagnosed type 2 diabetes underwent the following procedures: history taking, measurements of anthropometric parameters, office and ambulatory BP measurements, physical examination, laboratory analysis, and random and 24-hour urine analysis. RESULTS In total, there were 65 dippers and 37 nondipper patients. None of the anthropometric parameters were different between the dippers and the nondippers. There were 25 patients with SNT, 32 with WCHT, seven with MHT, and 38 with SHT. A comparison of anthropometric parameters between these four groups of patients showed that WC (P=0.016) and WHR (P=0.015) were different among all groups. According to regression analysis, only BMI was independently related with MHT (odds ratio [OR], 1.373, P=0.022), whereas only WC has been associated with SHT (OR, 1.321, P=0.041). CONCLUSION Among anthropometric parameters, only WC and WHR were different in SNT, WCHT, MHT, and SHT in newly diagnosed patients with type 2 diabetes.
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Affiliation(s)
- Baris Afsar
- Division of Nephrology, Department of Internal Medicine, Konya Numune State Hospital, Konya, Turkey
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Diagnosis of true uncontrolled hypertension using both home and ambulatory blood pressure monitoring. J Hum Hypertens 2013; 28:176-9. [DOI: 10.1038/jhh.2013.73] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 06/21/2013] [Accepted: 06/28/2013] [Indexed: 11/09/2022]
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Franklin SS, Thijs L, Li Y, Hansen TW, Boggia J, Liu Y, Asayama K, Björklund-Bodegård K, Ohkubo T, Jeppesen J, Torp-Pedersen C, Dolan E, Kuznetsova T, Stolarz-Skrzypek K, Tikhonoff V, Malyutina S, Casiglia E, Nikitin Y, Lind L, Sandoya E, Kawecka-Jaszcz K, Filipovsky J, Imai Y, Wang J, Ibsen H, O'Brien E, Staessen JA. Masked hypertension in diabetes mellitus: treatment implications for clinical practice. Hypertension 2013; 61:964-71. [PMID: 23478096 DOI: 10.1161/hypertensionaha.111.00289] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although distinguishing features of masked hypertension in diabetics are well known, the significance of antihypertensive treatment on clinical practice decisions has not been fully explored. We analyzed 9691 subjects from the population-based 11-country International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes. Prevalence of masked hypertension in untreated normotensive participants was higher (P<0.0001) among 229 diabetics (29.3%, n=67) than among 5486 nondiabetics (18.8%, n=1031). Over a median of 11.0 years of follow-up, the adjusted risk for a composite cardiovascular end point in untreated diabetic-masked hypertensives tended to be higher than in normotensives (hazard rate [HR], 1.96; 95% confidence interval [CI], 0.97-3.97; P=0.059), similar to untreated stage 1 hypertensives (HR, 1.07; CI, 0.58-1.98; P=0.82), but less than stage 2 hypertensives (HR, 0.53; CI, 0.29-0.99; P=0.048). In contrast, cardiovascular risk was not significantly different in antihypertensive-treated diabetic-masked hypertensives, as compared with the normotensive comparator group (HR, 1.13; CI, 0.54-2.35; P=0.75), stage 1 hypertensives (HR, 0.91; CI, 0.49-1.69; P=0.76), and stage 2 hypertensives (HR, 0.65; CI, 0.35-1.20; P=0.17). In the untreated diabetic-masked hypertensive population, mean conventional systolic/diastolic blood pressure was 129.2 ± 8.0/76.0 ± 7.3 mm Hg, and mean daytime systolic/diastolic blood pressure 141.5 ± 9.1/83.7 ± 6.5 mm Hg. In conclusion, masked hypertension occurred in 29% of untreated diabetics, had comparable cardiovascular risk as stage 1 hypertension, and would require considerable reduction in conventional blood pressure to reach daytime ambulatory treatment goal. Importantly, many hypertensive diabetics when receiving antihypertensive therapy can present with normalized conventional and elevated ambulatory blood pressure that mimics masked hypertension.
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Affiliation(s)
- Stanley S Franklin
- Heart Disease Prevention Program, Division of Cardiology, School of Medicine, University of California, Irvine, California, USA
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Smirnova MI, Oganov RG, Gorbunov MV, Deev AD, Andreeva GF. Masked inefficacy of arterial hypertension treatment: prevalence and predictors. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2011. [DOI: 10.15829/1728-8800-2011-6-11-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim.To assess the prevalence of masked inefficacy of arterial hypertension treatment (AH MTI) and its predictors in various clinical groups and for various blood pressure (BP) control strategies, in order to evaluate the true effectiveness of antihypertensive therapy (AHT).Material and methods.AHT effectiveness was assessed in two groups of the patients with Stage I-II AH (n=219 and n=39), by comparing the ratios of clinical (cl) to ambulatory (a) BP parameters. AH MTI was defined as elevated aBP and target clBP levels during AHT. The potential predictors of AH MTI included gender, age, body mass index (BMI), anamnestic data, frequency of the clinical visits to measure BP, quality of life (QoL) parameters (GWBQ questionnaire), circadian BP profile, orthostatic BP, and ECG signs of left ventricular hypertrophy (LVH).Results.AH MTI prevalence in Groups I and II was 11,0-15,7 % and 22,6-58,1 %, respectively, depending on the definition used. The groups were significantly different in terms of age, BMI, and QoL questionnaire III and VI domains. According to the regression analysis results, in Group I AH MTI was associated with QoL questionnaire II, V, and VI domains, baseline parameters of 24-hour BP monitoring, 24-hour systolic BP (SBP) variability, minimal daytime levels of mean BP, and metoprolol and atenolol therapy. In Group II, AH MTI was predicted by age, BMI, previously administered AHT, alcohol consumption, orthostatic SBP levels, Sokolow-Lyon index, Cornell voltage and Cornell product, Gubner index, and QoL questionnaire I, IV, and VI domains.Conclusion.AH MTI prevalence is associated with some baseline characteristics of the patients and the character of AHT. Due to regression to the mean, AH MTI prevalence could increase substantially when clBP parameters are measured more often.
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Affiliation(s)
| | | | | | - A. D. Deev
- State Research Centre for Preventive Medicine
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