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Contribution of single office aortic systolic blood pressure measurements to the detection of masked hypertension: data from two separate cohorts

Abstract

Masked hypertension (MH) and masked uncontrolled hypertension (MUH) remain largely underdiagnosed with no efficient detection algorithm. We recently proposed a novel classification of office systolic hypertension phenotypes defined on the basis of both brachial and aortic systolic blood pressure (bSBP/aSBP) and showed that type III (“isolated high office aSBP” phenotype: normal office bSBP but high office aSBP) has higher hypertension-mediated organ damage (HMOD). We tested whether MH/MUH (1) can be detected with the “isolated high office aSBP” phenotype and (2) if it is associated with elevated office aSBP with respect to normotension. We classified two separate and quite different cohorts (n = 391 and 956, respectively) on the basis of both bSBP and aSBP into four different phenotypes. Participants were classified as sustained hypertensives, masked hypertensives/masked uncontrolled hypertensives (MHs/MUHs), white coat hypertensives, and normotensives according to their office and out-of-office BP readings. The majority (more than 60% in cohort A and more than 50% in cohort B) of type III individuals were MHs/MUHs. Almost 35% of MHs/MUHs had optimal office bSBP rather than high normal bSBP. In both cohorts, the detection of more than 40% of MH/MUH was feasible with the type III phenotype. MHs/MUHs had higher office aSBP than individuals with sustained normotension (p < 0.05). In conclusion, in the absence of an efficient screening test, the diagnosis of MH/MUH can be assisted by the detection of the “isolated high office aSBP” phenotype, which can be measured in a single office visit. MHs/MUHs have increased aSBP relative to normotensives, further explaining the increased mortality of MH/MUH.

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References

  1. 1.

    O’donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. 2016;388:761–75.

    Article  Google Scholar 

  2. 2.

    Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937–52.

    Article  Google Scholar 

  3. 3.

    Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. ESC/ESH Guidelines for the management of arterial hypertension. J Hypertens. 2018;2018:1953–2041.

    Article  Google Scholar 

  4. 4.

    Thomas RJ, Jones DW, Ovbiagele B, Stafford RS, Spencer CC, Dennison Himmelfarb C, et al. 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. J Am Coll Cardiol. 2017;2017:e127–248.

    Google Scholar 

  5. 5.

    Fagard RH, Cornelissen VA. Incidence of cardiovascular events in white-coat, masked and sustained hypertension versus true normotension: a meta-analysis. J Hypertens. 2007;25:2193–8.

    CAS  Article  Google Scholar 

  6. 6.

    Cuspidi C, Facchetti R, Quarti-trevano F, Sala C, Tadic M, Grassi G, et al. Incident left ventricular hypertrophy in masked hypertension. Hypertension. 2019;74:56–62.

    CAS  Article  Google Scholar 

  7. 7.

    Stergiou GS, Asayama K, Thijs L, Kollias A, Niiranen TJ, Hozawa A, et al. Prognosis of white-coat and masked hypertension: International Database of Home blood pressure in relation to cardiovascular outcome. Hypertension. 2014;63:675–82.

    CAS  Article  Google Scholar 

  8. 8.

    Pierdomenico SD, Cuccurullo F. Prognostic value of white-coat and masked hypertension diagnosed by ambulatory monitoring in initially untreated subjects: an updated meta analysis. Am J Hypertens. 2011;24:52–8.

    Article  Google Scholar 

  9. 9.

    Triantafyllou A, Doumas M, Anyfanti P, Gkaliagkousi E, Zabulis X, Petidis K, et al. Divergent retinal vascular abnormalities in normotensive persons and patients with never-treated, masked, white coat hypertension. Am J Hypertens. 2013;26:318–25.

    CAS  Article  Google Scholar 

  10. 10.

    Pierdomenico SD, Pierdomenico AM, Coccina F, Clement DL, Buyzere MLD, Bacquer DAD, et al. Prognostic value of masked uncontrolled hypertension. Hypertension. 2018;72:862–9.

    CAS  Article  Google Scholar 

  11. 11.

    Complications TO, Events C, Coat W. Target organ complications and cardiovascular events associated with masked hypertension and white-coat hypertension: analysis from the Dallas Heart Study. J Am Coll Cardiol. 2016;66:2159–69.

    Google Scholar 

  12. 12.

    Zhang L, Li Y, Wei F, Thijs L, Kang Y, Wang S, et al. Strategies for classifying patients based on office, home, and ambulatory blood pressure measurement. Hypertension. 2015;65:1258–65.

    CAS  Article  Google Scholar 

  13. 13.

    Protogerou AD, Papaioannou TG, Blacher J, Papamichael CM, Lekakis JP, Safar ME. Central blood pressures: do we need them in the management of cardiovascular disease? Is it a feasible therapeutic target? J Hypertens. 2007;65:265–72.

    Article  Google Scholar 

  14. 14.

    Avolio AP, Bortel LMV, Boutouyrie P, Cockcroft JR, Mceniery CM, Protogerou AD, et al. Experts’ opinion and review of the data pulse wave amplification: basic definitions. Hypertension. 2009;54:375–83.

    CAS  Article  Google Scholar 

  15. 15.

    Kollias A, Lagou S, Zeniodi ME, Boubouchairopoulou N, Stergiou GS. Association of central versus brachial blood pressure with target-organ damage: systematic review and meta-analysis. Hypertension. 2016;67:183–90.

    CAS  Article  Google Scholar 

  16. 16.

    Huang CM, Wang KL, Cheng HM, Chuang SY, Sung SH, Yu WC, et al. Central versus ambulatory blood pressure in the prediction of all-cause and cardiovascular mortalities. J Hypertens. 2011;29:454–9.

    CAS  Article  Google Scholar 

  17. 17.

    Vlachopoulos C, Aznaouridis K, O’Rourke MF, Safar ME, Baou K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and meta-analysis. EurHeart J. 2010;31:1865–71.

    Google Scholar 

  18. 18.

    Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of Cardiovascular events and all-cause mortality with arterial stiffness. a systematic review and meta-analysis. J Am Coll Cardiol. 2010;55:1318–27.

    Article  Google Scholar 

  19. 19.

    Protogerou AD, Stergiou GS, Vlachopoulos C, Blacher J, Achimastos A. The effect of antihypertensive drugs on central blood pressure beyond peripheral blood pressure. Part II: evidence for specific class-effects of antihypertensive drugs on pressure amplification. Curr Pharm Des. 2009;15:272–89.

    CAS  Article  Google Scholar 

  20. 20.

    Sharman JE, Marwick TH, Gilroy D, Otahal P, Abhayaratna WP, Stowasser M, et al. Randomized trial of guiding hypertension management using central aortic blood pressure compared with best-practice care: principal findings of the BP GUIDE study. Hypertension. 2013;62:1138–45.

    CAS  Article  Google Scholar 

  21. 21.

    Cremer A, Boulestreau R, Gaillard P, Lainé M, Papaioannou G, Gosse P. Twenty-four-hour central pulse pressure for cardiovascular events prediction in a low-cardiovascular-risk population: results from the Bordeaux cohort. J Am Heart Assoc. 2018;7:e008225.

    Article  Google Scholar 

  22. 22.

    Weber T, Wassertheurer S, Rammer M, Maurer E, Hametner B, Mayer CC, et al. Validation of a brachial cuff-based method for estimating central systolic blood pressure. Hypertension. 2011;58:825–32.

    CAS  Article  Google Scholar 

  23. 23.

    Protogerou AD, Argyris A, Nasothimiou E, Vrachatis D, Papaioannou TG, Tzamouranis D, et al. Feasibility and reproducibility of noninvasive 24-h ambulatory aortic blood pressure monitoring with a brachial cuff-based oscillometric device. Am J Hypertens. 2012;25:876–82.

    Article  Google Scholar 

  24. 24.

    Herbert A, Cruickshank JK, Laurent S, Boutouyrie P. Establishing reference values for central blood pressure and its amplification in a general healthy population and according to cardiovascular risk factors. Eur Heart J. 2014;35:3122–33.

    CAS  Article  Google Scholar 

  25. 25.

    Protogerou AD, Aissopou EK, Argyris A, Nasothimiou EG, Konstantonis GD, Karamanou M, et al. Phenotypes of office systolic blood pressure according to both brachial and aortic measurements: frequencies and associations with carotid hypertrophy in 1861 adults. J Hypertens. 2016;34:1325–30.

    CAS  Article  Google Scholar 

  26. 26.

    Yu S, Xiong J, Lu Y, Chi C, Teliewubai J, Bai B, et al. The prevalence of central hypertension defined by a central blood pressure type I device and its association with target organ damage in community-dwelling elderly Chinese: The Northern Shanghai Study. J Am Soc Hypertens. 2018;12:211–9.

    Article  Google Scholar 

  27. 27.

    Papaioannou TG, Protogerou AD, Stamatelopoulos KS, Vavuranakis M, Stefanadis C. Non-invasive methods and techniques for central blood pressure estimation: procedures, validation, reproducibility and limitations. Curr Pharm Des. 2009;15:245–53.

    CAS  Article  Google Scholar 

  28. 28.

    Cheng HM, Chuang SY, Sung SH, Yu WC, Pearson A, Lakatta EG, et al. Derivation and validation of diagnostic thresholds for central blood pressure measurements based on long-term cardiovascular risks. J Am Coll Cardiol. 2013;62:1780–7.

    Article  Google Scholar 

  29. 29.

    Stergiou G, Kyriakoulis K, McManus R, Andreadis E, Jula A, Kollias A, et al. Phenotypes of masked hypertension isolated ambulatory, isolated home and dual masked hypertension. J Hypertens. 2020;38:218–23.

    CAS  Article  Google Scholar 

  30. 30.

    Trudel X, Milot A, Brisson C. Persistence and progression of masked hypertension: a 5-year prospective study. Int J Hypertens. 2013;2013:1–7.

    Article  Google Scholar 

  31. 31.

    Ware LJ, Rennie KL, Gafane LF, Nell TM, Socsc B, Thompson JES, et al. Masked hypertension in low-income South African adults. J Clin Hypertens. 2016;18:396–404.

    Article  Google Scholar 

  32. 32.

    Thompson JES, Smith W, Ware LJ, Mels CMC, Rooyen JMV, Huisman HW, et al. Masked hypertension and its associated cardiovascular risk in young individuals: the African-PREDICT study. Hypertens Res. 2015;39:158–65.

    Article  Google Scholar 

  33. 33.

    Paiva AMG, Gomes MICM, Campana ÉMG, Feitosa ADM, Sposito AC, Mota-Gomes MA, et al. Impact of hypertension phenotypes on the office and 24-h pulse wave velocity and augmentation index in individuals with or without antihypertensive medication use. Hypertens Res. 2019;42:1989–95.

    CAS  Article  Google Scholar 

  34. 34.

    Briasoulis A, Androulakis E, Palla M, Papageorgiou N, Tousoulis D. White-coat hypertension and cardiovascular events: a meta-analysis. J Hypertens. 2016;34:593–9.

    CAS  Article  Google Scholar 

  35. 35.

    Huang Y, Huang W, Mai W, Cai X, An D, Liu Z, et al. White-coat hypertension is a risk factor for cardiovascular diseases and total mortality. J Hypertens. 2017;35:677–88.

    CAS  Article  Google Scholar 

  36. 36.

    Sarafidis PA, Georgianos I, Karpetas A. Evaluation of a novel brachial cuff-based oscillometric method for estimating central systolic pressure in hemodialysis patients. Am J Nephrol. 2014;400:242–50.

    Article  Google Scholar 

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Correspondence to Eugenia Gkaliagkousi.

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Gkaliagkousi, E., Protogerou, A.D., Argyris, A.A. et al. Contribution of single office aortic systolic blood pressure measurements to the detection of masked hypertension: data from two separate cohorts. Hypertens Res 44, 215–224 (2021). https://doi.org/10.1038/s41440-020-00550-9

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Keywords

  • Masked hypertension
  • Aortic systolic blood pressure
  • Brachial systolic blood pressure
  • White coat hypertension

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