Abstract
Recently, the existence of so-called masked hypertension has attracted attention. In this study, the reproducibility of masked hypertension determined from morning and evening home blood pressure measurements was examined over a 6-month period. Home blood pressure measurements were taken consecutively for 7 days in volunteers at a company in 2002 and again in 2003. The 503 Japanese subjects (329 male, 174 female, mean age: 39.4 years), who were not taking antihypertensive drugs, were asked to measure their home blood pressure three times every morning and three times every evening. We defined casual blood pressure ≥140 (systolic) or ≥90 (diastolic) mmHg and home blood pressure ≥135 or ≥85 mmHg as hypertension. We also defined normotension as <140 and <90 mmHg in casual blood pressure and <135 and <85 mmHg in home blood pressure. We examined the reproducibility of four blood pressure categories (normotension, hypertension, white-coat hypertension, and masked hypertension) over a 6-month period. When measured in morning home blood pressure, the reproducibility of masked hypertension (59.1%) was significantly higher than that of white-coat hypertension (25.0%) and similar to that of hypertension (67.6%). However, the reproducibility of masked hypertension (23.5%) was similar to that of white-coat hypertension (32.0%) and significantly lower than that of hypertension (66.7%) when determined using evening home blood pressure. The concordances in the four blood pressure categories between the two periods were 0.582 (κ coefficient) and 0.463 when determined using morning and evening home blood pressure data, respectively. In conclusion, the reproducibility of masked hypertension over a 6-month period was moderate in an urban Japanese population when evaluated by morning home blood pressure.
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Asmar R, Zanchetti A : Guidelines for the use of self-blood pressure monitoring: a summary report of the first international consensus conference. J Hypertens 2000; 18: 493–508.
O'Brien E, Asmar R, Beilin L, et al: European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens 2003; 21: 821–848.
Imai Y, Otsuka K, Kawano Y, et al, on behalf of the Japanese Society of Hypertension : Japanese Society of Hypertension (JSH) guidelines for self-monitoring of blood pressure at home. Hypertens Res 2003; 26: 771–782.
Pickering TG, Hall JE, Appel LJ, et al: Recommendations for blood pressure measurement in humans and experimental animals. Part 1: Blood pressure measurement in humans. A statement for professionals from the subcommittee of professional and public education of the American Heart Association Council on high blood pressure research. Hypertension 2005; 45: 142–161.
Pickering TG, Davidson K, Gerin W, Schwartz JE : Masked hypertension. Hypertension 2002; 40: 795–796.
Wing LMH, Brown MA, Beilin LJ, Ryan P, Reid CM : ‘Reverse white-coat hypertension’ in older hypertensives. J Hypertens 2002; 20: 639–644.
Mancia G : Reversed white-coat hypertension: definition, mechanisms and prognostic implications. J Hypertens 2002; 20: 579–581.
Liu JE, Roman MJ, Pini R, Schwartz JE, Pickering TG, Devereux RB : Cardiac and arterial target organ damage in adults with elevated ambulatory and normal office blood pressure. Ann Intern Med 1999; 131: 564–572.
Selena C, Hogan BE, Linden W : How often do office blood pressure measurements fail to identify true hypertension? An exploration of white-coat normotension. Arch Fam Med 2000; 9: 533–540.
Bobrie G, Chatellier G, Genes N, et al: Cardiovascular prognosis of “masked hypertension” detected by blood pressure self-measurement in elderly treated hypertensive patients. JAMA 2004; 291: 1342–1349.
Kawabe H, Saito I : Influence of age and sex on prevalence of masked hypertension determined from home blood pressure measurements. J Hum Hypertens 2007; 21: 94–95.
Japanese Society of Hypertension : Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2004). Hypertens Res 2006; 29 ( Suppl): S1–S105.
Landis JR, Koch GG : The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159–177.
Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Porcellati C : White-coat hypertension: not guilty when correctly defined. Blood Press Monit 1998; 3: 147–152.
Kario K, Shimada K, Schwartz JE, Matsuo T, Hoshide S, Pickering TG : Silent and clinically overt stroke in older Japanese subjects with white-coat and sustained hypertension. J Am Coll Cardiol 2001; 38: 238–245.
Belkic KL, Schnall PL, Landsbergis PA, et al: Hypertension at the workplace: an occult disease? The need for work site surveillance. Adv Psychosom Med 2001; 22: 116–138.
Imai Y, Tsuji I, Nagai K, et al: Ambulatory blood pressure monitoring in evaluating the prevalence of hypertension in adults in Ohasama, a rural Japanese community. Hypertens Res 1996; 19: 207–212.
Sega R, Trocino G, Lanzarotti A, et al: Alterations of cardiac structure in patients with isolated office, ambulatory, or home hypertension. Data from the general population (Pressione Arteriose Monitorate e Loro Associazioni [PAMELA] study). Circulation 2001; 104: 1385–1392.
Imai Y, Nishiyama A, Sekino M, et al: Characteristics of blood pressure measured at home in the morning and in the evening: the Ohasama study. J Hypertens 1999; 17: 889–898.
Kawabe H, Saito I : Influence of nighttime bathing on evening home blood pressure measurements: how long should the interval be after bathing? Hypertens Res 2006; 29: 129–133.
Moreira LB, Fuchs FD, Moraes RS, Bredemeier M, Duncan BB : Alcohol intake and blood pressure: the importance of time elapsed since last drink. J Hypertens 1998; 16: 175–180.
Kawano Y, Pontes CS, Abe H, Takishita S, Omae T : Effects of alcohol consumption and restriction on home blood pressure in hypertensive patients: serial changes in the morning and evening records. Clin Exp Hypertens 2002; 24: 33–39.
Kawabe H, Saito I, Saruta T : Effects of nighttime alcohol intake on evening and next morning home blood pressure in Japanese normotensives. Clin Exp Hypertens 2007; 29: 43–49.
Kawabe H, Saito I, Saruta T : Influence of repeated measurement on one occasion, on successive days, and on workdays on home blood pressure values. Clin Exp Hypertens 2005; 27: 215–222.
Kawabe H, Saito I, Saruta T : Status of home blood pressure measured in morning and evening: evaluation in normotensives and hypertensives in Japanese urban population. Hypertens Res 2005; 28: 491–498.
Munakata M, Saito Y, Nunokawa T, Ito N, Fukudo S, Yoshinaga K : Clinical significance of blood pressure response triggered by a doctor's visit in patients with essential hypertension. Hypertens Res 2002; 25: 343–349.
Stergiou GS, Baibas NM, Gantzarou AP, et al: Reproducibility of home, ambulatory, and clinic blood pressure: implications for the design of trials for the assessment of antihypertensive drug efficacy. Am J Hypertens 2002; 15: 101–104.
Kawabe H, Saito I : Which measurement of home blood pressure should be used for clinical evaluation when multiple measurements are made? J Hypertens 2007; 25: 1369–1374.
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Kawabe, H., Saito, I. Reproducibility of Masked Hypertension Determined from Morning and Evening Home Blood Pressure Measurements over a 6-Month Period. Hypertens Res 30, 845–851 (2007). https://doi.org/10.1291/hypres.30.845
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DOI: https://doi.org/10.1291/hypres.30.845
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