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Prevalence of white-coat and masked hypertension in national and international registries

Abstract

In the past two decades, techniques for the measurement of blood pressure outside the medical setting have unmasked highly prevalent situations. A significant proportion of patients with office blood pressure levels above the thresholds for diagnosing hypertension or above the limits where those being treated are considered to be adequately controlled actually show normal ambulatory blood pressure levels. These patients have white-coat hypertension if untreated or false resistance to antihypertensive therapy because of the white-coat effect if treated. However, some individuals with normal office blood pressure measurements show elevated ambulatory blood pressure levels, and thus have masked hypertension if untreated or masked uncontrolled hypertension if treated. When looking for white-coat hypertension in patients with elevated office blood pressure levels or when looking for masked hypertension in office-controlled patients, up to one in three patients in each scenario would have white-coat or masked hypertension. Although related clinical factors, such as age, gender and global cardiovascular risk, are associated with both conditions, their abilities to predict such a misclassification are very low. Thus, assessing individual blood pressure levels by means of an ambulatory technique, particularly ambulatory blood pressure monitoring, is now considered a priority in diagnosing hypertension and in evaluating hypertension control.

Introduction

Cardiovascular disease is the leading cause of mortality worldwide, accounting for 30% of all deaths.1 Having a blood pressure (BP) above optimal limits is the main risk factor for cardiovascular and renal diseases, thus constituting the main determinant of mortality and disability worldwide.2 In spite of the efforts made by health services to prevent cardiovascular disease, the prevalence of hypertension is growing, and it is expected to affect up to one in three adult individuals by 2025.3

The vast majority of the body of knowledge about hypertension has been built on the assessment of BP by means of the traditional auscultatory measurement at an office or clinic. Nevertheless, the main limitation of this technique, apart from observer bias, comes from offering only a momentary BP measurement, usually under circumstances that can influence the BP level.4 To improve the assessment of actual 24-h BP levels, techniques for obtaining automated BP profiles over 24 h and BP measurements at home have been developed. Ambulatory BP monitoring (ABPM) is now the gold standard method for evaluating true BP levels, providing a more accurate estimation of true individual BP.5, 6, 7, 8, 9, 10, 11, 12

Methods

The authors searched PubMed for ‘white-coat hypertension (WCH),’ ‘white-coat effect,’ ‘isolated clinic hypertension,’ ‘masked hypertension (MH)’ and ‘isolated ambulatory hypertension.’ Inclusion criteria for the present review were (1) studies from national and international registries of ABPM and/or home BP monitoring, and (2) studies containing information about the prevalence of WCH in hypertensive patients and the prevalence of MH in normotensive office-controlled patients, respectively.

Misclassification of blood pressure status in the office

In clinical practice, the main indication for ABPM is to accurately determine an individual’s BP.4 Misclassification of BP status can occur in one out of three hypertensive subjects.13, 14, 15 Disagreements between office and ambulatory BP assessments arise from two conditions, that is, WCH and MH.

The term WCH was introduced by Pickering et al.16 to describe the condition, in which untreated patients have high BP readings at their doctor’s office but normal BP levels outside the medical setting. This situation is also called isolated clinic hypertension. The term white-coat effect has been defined as the rise in BP that occurs in the medical environment; patients presenting with an office BP at least 20 mm Hg systolic and/or 10 mm Hg diastolic higher than the awake ambulatory BP have been designated as having a significant white-coat effect.4 Treated patients presenting with uncontrolled BP at the office but normal ambulatory BP values have been designated as pseudo-resistant or false-resistant hypertensives because of the white-coat effect.4 In the epidemiologic approach to hypertension control, this condition has been termed office-resistant control or underestimation of BP control at the office.13

MH is defined as untreated individuals with normal office BPs, usually <140/90 mm Hg, but elevated BPs on ABPM or home BP measurements, usually 135/85 mm Hg for daytime values. MH and its related risks have previously been recognized for both treated and untreated subjects.4,15,17, 18, 19 For treated hypertensive patients, the preferred term is masked uncontrolled hypertension.

Current definitions of white-coat hypertension and masked hypertension

Until now, many definitions have been used in assessing WCH and MH. Initially, studies defined WCH as having an office systolic BP 140 mm Hg and/or diastolic BP 90 mm Hg and an out-of-office daytime (awake) BP <135/85 mm Hg. More recently, studies have defined WHC as an elevated office BP but a 24-h ambulatory BP <130/80 mm Hg, recognizing that nocturnal BP has a remarkable impact on a patient’s prognosis.

The current definition of WCH, as recently proposed in an ad hoc position paper of the European Society of Hypertension Working Group on BP monitoring, includes normality in the three conventional ABPM periods, that is, daytime, nighttime and 24 h, to diagnose WCH.4 As mentioned above, the term WCH, or isolated clinical hypertension, should be reserved for untreated patients; thus, the term is used mainly for diagnostic purposes. Treated patients with an office BP 140/90 mm Hg and normal ambulatory BP values should be designated as having pseudo-resistant or false-resistant hypertension because of a white-coat effect. By contrast, MH should be defined in untreated patients who have normal office BP levels but a daytime BP 135/85 mm Hg, nighttime BP 120/70 mm Hg or 24 h BP 130/80 mm Hg. When this situation occurs in a treated patient, the term ‘masked uncontrolled hypertension’ should be used.4,15 These definitions are summarized in Table 1.

Table 1 Definitions of white-coat hypertension and masked hypertension according to the 2013 ESH Position Paper on Ambulatory BP monitoring4

Differences between office and ambulatory blood pressures

As stated above, many patients present with a stress reaction when visiting a doctor or nurse, or even when performing a self-automated BP measurement in a medical environment, and show an office BP that may be significantly higher than their BP levels during normal daily activities. Data from 51 573 hypertensive patients included in the Spanish ABPM Registry showed that daytime BPs were ≈16/8 mm Hg lower than office BPs, and this difference reached ≈20/10 mm Hg when comparing office and 24 h BPs (Figure 1). The higher the BP or global cardiovascular risk level, the greater the difference between office and ambulatory BP values, as shown by our group in the comparison between patients with high-risk hypertension and patients with low-to-moderate-risk hypertension. These data are summarized in Table 2.20 We also discovered significant gender differences between office and ambulatory BP levels. Women showed higher office BP values than men, despite receiving the same amount of antihypertensive treatment. These office differences were related to a more advanced age (63.9 vs. 60.1 years) and a higher prevalence of obesity (44.4 vs. 37.3%) in women. Nevertheless, rounded differences between office and 24 h BP levels were 18/9 mm Hg in men and 22/13 mm Hg in women. Consequently, women showed higher control rates of ambulatory BP levels than men.21

Figure 1
figure1

Office and ambulatory blood pressure levels in 51 573 hypertensive patients from the Spanish Ambulatory Blood Pressure Monitoring Registry.

Table 2 Differences between office and ambulatory blood pressure in high-risk vs. low-to-moderate-risk hypertensives

Prevalence of white-coat hypertension in the Spanish ABPM Registry

The Spanish ABPM Registry was developed in 2004 with the goal of promoting the use of ABPM in primary care settings. More than 1200 general physicians were trained in the ABPM technique and in the use of a web platform (www.cardiorisc.com) that receives ABPM data and clinical records from individual patients and generates a results report in real time. Data are stored in a safe database and have been used for a series of investigations including the assessment of WCH in general treated hypertensives,13 as well as different hypertensive populations, that is, untreated hypertensives,14 treated male versus female hypertensives,21 hypertensives with coronary heart disease,22 very elderly hypertensives,23 resistant hypertensives,24 diabetics25 and hypertensives with chronic kidney disease.26 The prevalence of WCH ranged from 15.5 to 29.2% in untreated patients, and the prevalence of false-resistant hypertension due to the white-coat effect ranged from 24.2% in treated males to 37.5% in hypertensives resistant to three or more drugs. Complete data about the prevalence of WCH and false resistance due to the white-coat effect are displayed in Table 3. In one of the analyses, the abilities of physicians to predict WCH in untreated hypertensives was assessed but yielded discouraging results. When WCH was suspected, only 33.7% of the results obtained were positive, and when it was not suspected, 26.0% of patients displayed WCH. Predictors of WCH as a cause of false office resistant control are displayed in Table 4. The most consistent variables associated with WCH were age, female gender, a higher body mass index, and less target-organ damage or established cardiovascular disease.

Table 3 Prevalence of white-coat hypertension within hypertensive patients in different subgroups obtained from the Spanish ABPM Registry
Table 4 Predictors of white-coat hypertension in multivariate logistic analyses from specific groups of the Spanish ABPM Registry

Prevalence of white-coat hypertension in other national and international registries

Most cited information about WCH diagnosed by means of ABPM in national registries comes from Italy,18,27, 28, 29 Ireland,30 Japan31,32 and Denmark.33,34 Furthermore, the Finn-Home and Didima studies assessed WCH using self-administered home blood pressure monitoring.35,36 Finally, the International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes (IDACO) study included a large number of subjects from several countries.37

Data about WCH within subjects with office hypertension are summarized in Table 5. The prevalence of WCH ranged from ≈10 to ≈50%, depending on the definition of normal for ambulatory BPs and/or on the studied population. All of these studies showed that WCH occurred very frequently, supporting the previous idea that 30–40% of the subjects classified as having hypertension in a medical environment have normal ambulatory BPs.38 Consequently, ABPM has been indicated as the first step for diagnosing hypertension after the detection of an office BP 140/90 mm Hg by current British NICE (National Institute for Health and Clinical Excellence) recommendations.39 Moreover, recent guidelines from the European Societies of Hypertension and Cardiology defined hypertension by both office and ambulatory thresholds and indicates assessing ambulatory BPs to rule out WCH in a broad range of situations, such as grade 1 hypertension at the office or high office BPs in individuals without asymptomatic organ damage and at low cardiovascular risk.40 Furthermore, ambulatory-based assessments of hypertension control are far better than office-based ones, conveying the encouraging message to physicians that the patients are faring better than shown by the data retrieved in in-office evaluations.13 In some specific patients, such as resistant hypertensives, the prevalence of the white-coat effect could be even higher than within the general hypertensive population,24 so assessing ambulatory BPs has also been considered to be the first procedure for diagnosing resistant hypertension.41

Table 5 Prevalence of white-coat hypertension within hypertensives in national and international databases other than the Spanish ABPM Registry

Prevalence of masked hypertension in national and international registries

MH is considered to be the opposite of the more commonly recognized WHC. As stated before, the term MH should be used for untreated individuals who have normal office BPs but elevated ambulatory BPs. For treated patients, this condition should be termed masked uncontrolled hypertension.4,15 Assessing the prevalence of MH in whole samples of a population of hypertensives would underestimate the magnitude of the problem. The MH prevalence in population studies averaged 13%19 and was previously estimated as <10% of the global hypertension population (Figure 2). Nevertheless, when looking for MH within office-controlled patients, up to 1 in 3 could have MH. Table 6 shows data regarding the prevalence of MH in various cohorts of controlled hypertensives from the Spanish ABPM Registry.15,21, 22, 23, 24, 25, 26 Table 7 shows corresponding data from other national and international registries, including those mentioned in the WCH section,18,27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37 and 3 other studies from Sweden, Japan, and France.42, 43, 44

Figure 2
figure2

Distribution of 51 573 hypertensive patients from the Spanish Ambulatory Blood Pressure Monitoring Registry according to office and daytime ambulatory blood pressure criteria.

Table 6 Prevalence of masked hypertension in office-controlled hypertensives in different populations from the Spanish ABPM Registry
Table 7 Prevalence of masked hypertension within subjects with normal office blood pressure in national and international databases other than the Spanish ABPM Registry

Patients with WCH are at risk of being managed as true hypertensives, undergoing laboratory tests, and overtreatment. On the other hand, patients with MH are at risk of under-detection and under-treatment. Because over one in three office-controlled patients could have MH, predictors of this condition are of key importance to detecting an ambulatory lack of BP control. In a recent analysis of the Spanish ABPM Registry, the clinical profile of patients with MH included male gender, obese, longer duration of hypertension, smoking habit, and diabetes: that is, patients with a high risk of an adverse cardiovascular event. Office BPs in the high-normal range (systolic 130–139 mm Hg and/or diastolic 85–89 mm Hg) also predicted MH.15 These findings were consistent with data from previous studies looking for predictors of MH.19,43,44

Conclusions

Physicians are prone to two types of misclassifications when assessing BP statuses solely at the office. WCH and MH are highly prevalent conditions that could be present in up to one in three patients with seemingly uncontrolled BP and one in three with controlled BP, respectively. Patients with WCH are more frequently women, older, obese and have a low cardiovascular risk profile. Patients with MH are more frequently men, younger, obese, smokers, and have high-normal BPs at their doctor’s office and a higher cardiovascular risk. Nevertheless, many patients with any of these predictors could have WCH or MH. Assessing ambulatory BPs using ABPM (and possibly by home BP monitoring if ABPM is not available) should be encouraged in the current management of hypertensive patients, both for diagnosis and for evaluation of BP control.

References

  1. 1

    Lawes CM, Vander Hoorn S, Rodgers A . Global burden of blood-pressure-related disease, 2001. Lancet 2008; 371: 1513–1518.

    Article  Google Scholar 

  2. 2

    Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, Amann M, Anderson HR, Andrews KG, Aryee M, Atkinson C, Bacchus LJ, Bahalim AN, Balakrishnan K, Balmes J, Barker-Collo S, Baxter A, Bell ML, Blore JD, Blyth F, Bonner C, Borges G, Bourne R, Boussinesq M, Brauer M, Brooks P, Bruce NG, Brunekreef B, Bryan-Hancock C, Bucello C, Buchbinder R, Bull F, Burnett RT, Byers TE, Calabria B, Carapetis J, Carnahan E, Chafe Z, Charlson F, Chen H, Chen JS, Cheng AT, Child JC, Cohen A, Colson KE, Cowie BC, Darby S, Darling S, Davis A, Degenhardt L, Dentener F, Des Jarlais DC, Devries K, Dherani M, Ding EL, Dorsey ER, Driscoll T, Edmond K, Ali SE, Engell RE, Erwin PJ, Fahimi S, Falder G, Farzadfar F, Ferrari A, Finucane MM, Flaxman S, Fowkes FG, Freedman G, Freeman MK, Gakidou E, Ghosh S, Giovannucci E, Gmel G, Graham K, Grainger R, Grant B, Gunnell D, Gutierrez HR, Hall W, Hoek HW, Hogan A, Hosgood HD 3rd, Hoy D, Hu H, Hubbell BJ, Hutchings SJ, Ibeanusi SE, Jacklyn GL, Jasrasaria R, Jonas JB, Kan H, Kanis JA, Kassebaum N, Kawakami N, Khang YH, Khatibzadeh S, Khoo JP, Kok C, Laden F, Lalloo R, Lan Q, Lathlean T, Leasher JL, Leigh J, Li Y, Lin JK, Lipshultz SE, London S, Lozano R, Lu Y, Mak J, Malekzadeh R, Mallinger L, Marcenes W, March L, Marks R, Martin R, McGale P, McGrath J, Mehta S, Mensah GA, Merriman TR, Micha R, Michaud C, Mishra V, Mohd Hanafiah K, Mokdad AA, Morawska L, Mozaffarian D, Murphy T, Naghavi M, Neal B, Nelson PK, Nolla JM, Norman R, Olives C, Omer SB, Orchard J, Osborne R, Ostro B, Page A, Pandey KD, Parry CD, Passmore E, Patra J, Pearce N, Pelizzari PM, Petzold M, Phillips MR, Pope D, Pope CA 3rd, Powles J, Rao M, Razavi H, Rehfuess EA, Rehm JT, Ritz B, Rivara FP, Roberts T, Robinson C, Rodriguez-Portales JA, Romieu I, Room R, Rosenfeld LC, Roy A, Rushton L, Salomon JA, Sampson U, Sanchez-Riera L, Sanman E, Sapkota A, Seedat S, Shi P, Shield K, Shivakoti R, Singh GM, Sleet DA, Smith E, Smith KR, Stapelberg NJ, Steenland K, Stöckl H, Stovner LJ, Straif K, Straney L, Thurston GD, Tran JH, Van Dingenen R, van Donkelaar A, Veerman JL, Vijayakumar L, Weintraub R, Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams W, Wilson N, Woolf AD, Yip P, Zielinski JM, Lopez AD, Murray CJ, Ezzati M, AlMazroa MA, Memish ZA . A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2224–2260.

    Article  Google Scholar 

  3. 3

    Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J . Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365: 1307–1315.

    Article  Google Scholar 

  4. 4

    O'Brien E, Parati G, Stergiou G, Asmar R, Beilin L, Bilo G, Clement D, de la Sierra A, de Leeuw P, Dolan E, Fagard R, Graves J, Head GA, Imai Y, Kario K, Lurbe E, Mallion JM, Mancia G, Mengden T, Myers M, Ogedegbe G, Ohkubo T, Omboni S, Palatini P, Redon J, Ruilope LM, Shennan A, Staessen JA, vanMontfrans G, Verdecchia P, Waeber B, Wang J, Zanchetti A, Zhang Y . On behalf of the European Society of Hypertension Working Group on Blood Pressure Monitoring European Society of Hypertension position paper on ambulatory blood pressure monitoring. J Hypertens 2013; 31: 1731–1768.

    CAS  Article  Google Scholar 

  5. 5

    Verdecchia P, Porcellati C, Schillaci G, Borgioni C, Ciucci A, Battistelli M, Guerrieri M, Gatteschi C, Zampi I, Santucci A, Santucci C, Reboldi G . Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension. Hypertension 1994; 24: 793–801.

    CAS  Article  Google Scholar 

  6. 6

    Staessen JA, Thijs L, Fagard R, O'Brien ET, Clement D, de Leeuw PW, Mancia G, Nachev C, Palatini P, Parati G, Tuomilehto J, Webster J . Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. Systolic hypertension in Europe Trial Investigators. JAMA 1999; 282: 539–546.

    CAS  Article  Google Scholar 

  7. 7

    Clement DL, De Buyzere ML, De Bacquer DA, de Leeuw PW, Duprez DA, Fagard RH, Gheeraert PJ, Missault LH, Braun JJ, Six RO, Van Der Niepen P, O'Brien E . Office versus Ambulatory Pressure Study Investigators Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. N Engl J Med 2003; 348: 2407–2415.

    Article  Google Scholar 

  8. 8

    Kikuya M, Ohkubo T, Asayama K, Metoki H, Obara T, Saito S, Hashimoto J, Totsune K, Hoshi H, Satoh H, Imai Y . Ambulatory blood pressure and 10-year risk of cardiovascular and noncardiovascular mortality: the Ohasama study. Hypertension 2005; 45: 240–245.

    CAS  Article  Google Scholar 

  9. 9

    Sega R, Facchetti R, Bombelli M, Cesana G, Corrao G, Grassi G, Mancia G . Prognostic value of ambulatory and home blood pressures compared with office blood pressure in the general population: follow-up results from the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study. Circulation 2005; 111: 1777–1783.

    Article  Google Scholar 

  10. 10

    Dolan E, Stanton A, Thijs L, Hinedi K, Atkins N, McClory S, Den Hond E, McCormack P, Staessen JA, O'Brien E . Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study. Hypertension 2005; 46: 156–161.

    CAS  Article  Google Scholar 

  11. 11

    Hansen TW, Kikuya M, Thijs L, Björklund-Bodegård K, Kuznetsova T, Ohkubo T, Richart T, Torp-Pedersen C, Lind L, Jeppesen J, Ibsen H, Imai Y, Staessen JA . IDACO Investigators Prognostic superiority of daytime ambulatory over conventional blood pressure in four populations: a meta-analysis of 7,030 individuals. J Hypertens 2007; 25: 1554–1564.

    CAS  Article  Google Scholar 

  12. 12

    de la Sierra A, Banegas JR, Segura J, Gorostidi M, Ruilope LM . CARDIORISC Event Investigators Ambulatory blood pressure monitoring and development of cardiovascular events in high-risk patients included in the Spanish ABPM registry: the CARDIORISC Event study. J Hypertens 2012; 30: 713–719.

    CAS  Article  Google Scholar 

  13. 13

    Banegas JR, Segura J, Sobrino J, Rodríguez-Artalejo F, de la Sierra A, de la Cruz JJ, Gorostidi M, Sarría A, Ruilope LM . Spanish Society of Hypertension Ambulatory Blood Pressure Monitoring Registry Investigators Effectiveness of blood pressure control outside the medical setting. Hypertension 2007; 49: 62–68.

    CAS  Article  Google Scholar 

  14. 14

    Vinyoles E, Felip A, Pujol E, de la Sierra A, Durà R, del Rey RH, Sobrino J, Gorostidi M, de la Figuera M, Segura J, Banegas JR, Ruilope LM . On behalf of the Spanish Society of Hypertension ABPM Registry Clinical characteristics of isolated clinic hypertension. J Hypertens 2008; 26: 438–445.

    CAS  Article  Google Scholar 

  15. 15

    Banegas JR, Ruilope LM, de la Sierra A, de la Cruz JJ, Gorostidi M, Segura J, Martell N, García-Puig J, Deanfield J, Williams B . High prevalence of masked uncontrolled hypertension (MUCH) in people with treated hypertension. Eur Heart J (e-pub ahead of print 3 February 2014).

  16. 16

    Pickering TG, James GD, Boddie C, Harshfield GA, Blank S, Laragh JH . How common is white coat hypertension? JAMA 1988; 259: 225–228.

    CAS  Article  Google Scholar 

  17. 17

    Pierdomenico SD, Lapenna D, Bucci A, Di Tommaso R, Di Mascio R, Manente BM, Caldarella MP, Neri M, Cuccurullo F, Mezzetti A . Cardiovascular outcome in treated hypertensive patients with responder, masked, false resistant, and true resistant hypertension. Am J Hypertens 2005; 18: 1422–1428.

    Article  Google Scholar 

  18. 18

    Mancia G, Facchetti R, Bombelli M, Grassi G, Sega R . Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure. Hypertension 2006; 47: 846–853.

    CAS  Article  Google Scholar 

  19. 19

    Bobrie G, Clerson P, Ménard J, Postel-Vinay N, Chatellier G, Plouin PF . Masked hypertension: a systematic review. J Hypertens 2008; 26: 1715–1725.

    CAS  Article  Google Scholar 

  20. 20

    Gorostidi M, Sobrino J, Segura J, Sierra C, de la Sierra A, Hernandez del Rey R, Vinyoles E, Galcerán JM, López-Eady MD, Marín R, Banegas JR, Sarría A, Coca A, Ruilope LM . On behalf of the Spanish Society of Hypertension ABPM Registry investigators Ambulatory blood pressure monitoring in hypertensive patients with high cardiovascular risk: a cross-sectional analysis of a 20 000-patient database in Spain. J Hypertens 2007; 25: 977–984.

    CAS  Article  Google Scholar 

  21. 21

    Banegas JR, Segura J, de la Sierra A, Gorostidi M, Rodríguez-Artalejo F, Sobrino J, de la Cruz JJ, Vinyoles E, Hernández del Rey R, Graciani A, Ruilope LM . On behalf of the Spanish Society of Hypertension ABPM Registry Investigators Gender differences in office and ambulatory control of hypertension. Am J Med 2008; 121: 1078–1084.

    Article  Google Scholar 

  22. 22

    Banegas JR, de la Sierra A, Segura J, Gorostidi M, de la Cruz J, Rodríguez-Artalejo F, Ruilope LM . Control of hypertension in coronary heart disease. Int J Cardiol 2009; 134: 245–247.

    CAS  Article  Google Scholar 

  23. 23

    Llisterri JL, Alonso FJ, Gorostidi M, Sierra C, de la Sierra A, Banegas JR, Segura J, Sobrino J, de la Cruz JJ, Madruga F, Aranda P, Redon J, Ruilope LM . En representación de los investigadores del Proyecto CARDIORISC-MAPAPRES. Sociedad Española de Hipertensión–Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA) Differences between office and ambulatory control of hypertension in very elderly patients. The CARDIORISC - MAPAPRES project. Med Clin (Barc) 2009; 133: 769–776.

    Article  Google Scholar 

  24. 24

    de la Sierra A, Segura J, Banegas JR, Gorostidi M, de la Cruz JJ, Armario P, Oliveras A, Ruilope LM . Clinical features of 8295 patients with resistant hypertension classified on the basis of ambulatory blood pressure monitoring. Hypertension 2011; 57: 898–902.

    CAS  Article  Google Scholar 

  25. 25

    Gorostidi M, de la Sierra A, González-Albarrán O, Segura J, de la Cruz JJ, Vinyoles E, Llisterri JL, Aranda P, Ruilope LM, Banegas JR . On behalf of the Spanish Society of Hypertension ABPM Registry investigators Abnormalities in ambulatory blood pressure monitoring in hypertensive patients with diabetes. Hypertens Res 2011; 34: 1185–1189.

    Article  Google Scholar 

  26. 26

    Gorostidi M, Sarafidis PA, de la Sierra A, Segura J, de la Cruz JJ, Banegas JR, Ruilope LM . On behalf of the Spanish ABPM Registry Differences between office and 24-hour blood pressure control in hypertensive patients with CKD: A 5693-patient cross-sectional analysis from Spain. Am J Kidney Dis 2013; 62: 285–294.

    Article  Google Scholar 

  27. 27

    Verdecchia P, Palatini P, Schillaci G, Mormino P, Porcellati C, Pessina AC . Independent predictors of isolated clinic ('white-coat') hypertension. J Hypertens 2001; 19: 1015–1020.

    CAS  Article  Google Scholar 

  28. 28

    Pierdomenico SD, Lapenna D, Di Mascio R, Cuccurullo F . Short- and long-term risk of cardiovascular events in white-coat hypertension. J Hum Hypertens 2008; 22: 408–414.

    CAS  Article  Google Scholar 

  29. 29

    Pierdomenico SD, Pannarale G, Rabbia F, Lapenna D, Licitra R, Zito M, Campanella M, Gaudio C, Veglio F, Cuccurullo F . Prognostic relevance of masked hypertension in subjects with prehypertension. Am J Hypertens 2008; 21: 879–883.

    Article  Google Scholar 

  30. 30

    Dolan E, Stanton A, Atkins N, Den Hond E, Thijs L, McCormack P, Staessen J, O'Brien E . Determinants of white-coat hypertension. Blood Press Monit 2004; 9: 307–309.

    CAS  Article  Google Scholar 

  31. 31

    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.

    CAS  Article  Google Scholar 

  32. 32

    Ohkubo T, Kikuya M, Metoki H, Asayama K, Obara T, Hashimoto J, Totsune K, Hoshi H, Satoh H, Imai Y . Prognosis of 'masked' hypertension and 'white-coat' hypertension detected by 24-h ambulatory blood pressure monitoring 10-year follow-up from the Ohasama study. J Am Coll Cardiol 2005; 46: 508–515.

    Article  Google Scholar 

  33. 33

    Hansen TW, Jeppesen J, Rasmussen S, Ibsen H, Torp-Pedersen C . Ambulatory blood pressure monitoring and risk of cardiovascular disease: a population based study. Am J Hypertens 2006; 19: 243–250.

    Article  Google Scholar 

  34. 34

    Gustavsen PH, Høegholm A, Bang LE, Kristensen KS . White coat hypertension is a cardiovascular risk factor: a 10-year follow-up study. J Hum Hypertens 2003; 17: 811–817.

    CAS  Article  Google Scholar 

  35. 35

    Hänninen MR, Niiranen TJ, Puukka PJ, Johansson J, Jula AM . Prognostic significance of masked and white-coat hypertension in the general population: the Finn-Home Study. J Hypertens 2012; 30: 705–712.

    Article  Google Scholar 

  36. 36

    Stergiou GS, Baibas NM, Kalogeropoulos PG . Cardiovascular risk prediction based on home blood pressure measurement: the Didima study. J Hypertens 2007; 25: 1590–1596.

    CAS  Article  Google Scholar 

  37. 37

    Franklin SS, Thijs L, Hansen TW, Li Y, Boggia J, Kikuya M, 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, Imai Y, Wang J, Ibsen H, O'Brien E, Staessen JA . International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes Investigators Significance of white-coat hypertension in older persons with isolated systolic hypertension: a meta-analysis using the International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes population. Hypertension 2012; 59: 564–571.

    CAS  Article  Google Scholar 

  38. 38

    Mancia G, Bombelli M, Seravalle G, Grassi G . Diagnosis and management of patients with white-coat and masked hypertension. Nat Rev Cardiol 2011; 8: 686–693.

    CAS  Article  Google Scholar 

  39. 39

    National Institute for Health and Clinical Excellence (NICE) Hypertension: clinical management of primary hypertension in adults. Clinical Guideline 127 National Institute for Health and Clinical Excellence (NICE): London, UK, 2011.

  40. 40

    Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, Christiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F . ESH/ESC Guidelines for the management of arterial hypertension. The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013; 31: 1281–1357.

    CAS  Article  Google Scholar 

  41. 41

    Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, White A, Cushman WC, White W, Sica D, Ferdinand K, Giles TD, Falkner B, Carey RM . Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation 2008; 117: e510–e526.

    Article  Google Scholar 

  42. 42

    Björklund K, Lind L, Zethelius B, Andrén B, Lithell H . Isolated ambulatory hypertension predicts cardiovascular morbidity in elderly men. Circulation 2003; 107: 1297–1302.

    Article  Google Scholar 

  43. 43

    Obara T, Ohkubo T, Funahashi J, Kikuya M, Asayama K, Metoki H, Oikawa T, Hashimoto J, Totsune K, Imai Y the J-HOME study group. Isolated uncontrolled hypertension at home and in the office among treated hypertensive patients from the J-HOME study. J Hypertens 2005; 23: 1653–1660.

    CAS  Article  Google Scholar 

  44. 44

    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 2006; 24: 2365–2370.

    CAS  Article  Google Scholar 

  45. 45

    Fagard RH, Van Den Broecke C, De Cort P . Prognostic significance of blood pressure measured in the office, at home and during ambulatory monitoring in older patients in general practice. J Hum Hypertens 2005; 19: 801–807.

    CAS  Article  Google Scholar 

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Correspondence to Alejandro de la Sierra.

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Gorostidi, M., Vinyoles, E., Banegas, J. et al. Prevalence of white-coat and masked hypertension in national and international registries. Hypertens Res 38, 1–7 (2015). https://doi.org/10.1038/hr.2014.149

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Keywords

  • ambulatory blood pressure monitoring
  • blood pressure control
  • masked hypertension
  • white-coat hypertension

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