Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Reproducibility of blood pressure phenotypes identified by office and ambulatory blood pressure in treated hypertensive patients. Data from the PHYLLIS study


Previous studies have shown that white-coat and masked uncontrolled hypertension (WUCH and MUCH, respectively) are clinical conditions with very poor reproducibility over time. This is also the case for the different nighttime blood pressure (BP) patterns (dipping, nondipping, reverse dipping or extreme dipping). Whether and to what extent the phenomenon might depend on the type of antihypertensive treatment is unknown. In the present study, we addressed this issue by analyzing the data collected in the Plaque Hypertension Lipid-Lowering Italian Study (PHYLLIS), in which office and ambulatory BP were measured three times during an almost 3-year treatment period. The results showed that a limited number of WUCH or MUCH patients at an initial office measurement and 24-h systolic (S) BP measurement maintained the same status at a second set of measurements one or more years later. This was also the case for all dipping patterns, and only a minimal number of patients exhibited the same phenotype throughout all on-treatment SBP measurements. The results were similar for treatment with a thiazide diuretic or an ACE inhibitor and are in line with those of the European Lacidipine Study on Atherosclerosis (ELSA) trial, i.e., the only other available trial with multiple on-treatment office and ambulatory BP measurements, in which patients were treated with a calcium channel blocker or a beta-blocker. All the BP patterns identified in hypertensive patients treated by joint office and ambulatory BP measurements display poor reproducibility, and this is unrelated to the type of antihypertensive treatment used.

This is a preview of subscription content, access via your institution

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. Zanchetti A, Bond MG, Hennig M, Neiss A, Mancia G, Dal Palù C, et al. European lacidipine study on atherosclerosis investigators. Calcium antagonist lacidipine slows down progression of asympomatic carotid atherosclerosis: principal results of the European Lacidipine Study on Atherosclerosis (ELSA), a randomized, double-blind, long-term trial. Circulation. 2002;106:2422–7.

    CAS  Article  Google Scholar 

  2. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104.

    Article  Google Scholar 

  3. Mancia G, Facchetti R, Cuspidi C, Bombelli M, Corrao G, Grassi G. Limited reproducibility of MUCH and WUCH: evidence from the ELSA study. Eur Heart J. 2020;41:1565–71.

    CAS  Article  Google Scholar 

  4. Mancia G, Facchetti R, Bombelli M, Quarti-Trevano F, Cuspidi C, Grassi G. Short- and long-term reproducibility of nighttime blood pressure and nocturnal blood pressure reduction. Hypertension. 2021;77:1745–55.

    CAS  Article  Google Scholar 

  5. Mancia G, Verdecchia P. Clinical value of ambulatory blood pressure: evidence and limits. Circ Res. 2015;116:1034–45.

    CAS  Article  Google Scholar 

  6. Zanchetti A, Crepaldi G, Bond MG, Gallus F, Veglia F, Mancia G, et al. Different effects of antihypertensive regimens based on fosinopril or hydrochlorotiazide with or without lipid lowering by pravastatin on progression of asymptomatic atherosclerosis:principal results of Phyllis - a randomized double-blind trial. Stroke. 2004;35:2807–12.

    CAS  Article  Google Scholar 

  7. Mancia G, Parati G, Revera M, Bilo G, Giuliano A, Veglia F, et al. Statins, antihypertensive treatment, and blood pressure control in clinic and over 24 h: evidence from Phyllis randomised double blind trial. BMJ. 2010;340:c1197.

    Article  Google Scholar 

  8. Mancia G, Facchetti R, Quarti-Trevano F, Grassi G. Antihypertensive drug treatment in white-coat hypertension: data from the plaque hypertension lipid-lowering Italian study. J Hypertens. 2022:40:in press.

  9. Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ, et al. AHA dietary guidelines-revision 2000: a statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation. 2000;102:2284–99.

    CAS  Article  Google Scholar 

  10. Stergiou GS, Palatini P, Parati G, O’Brien E, Januszewicz A, Lurbe E, et al. 2021 European Society of Hypertension practice guidelines for office and out-of-office blood pressure measurent. J Hypertens. 2021;39:1293–302.

    CAS  Article  Google Scholar 

  11. Zanchetti A, Hennig M, Hollweck R, Bond G, Tang R, Cuspidi C, et al. Baseline values but not treatment-induced carotid thickness predict incident cardiovascular events in treated hypertensive patients. Circulation. 2009;120:1084–90.

    Article  Google Scholar 

  12. Mancia G, Bertinieri G, Grassi G, Parati G, Pomidossi G, Ferrari A, et al. Effects of blood pressure measurement by the doctor on patient’s blood pressure and heart rate. Lancet. 1983;2:695–8.

    CAS  Article  Google Scholar 

  13. Mancia G, Parati G, Pomidossi G, Grassi G, Casadei R, Zanchetti A. Alerting reaction and rise in blood pressure during measurement by physician and nurse. Hypertension. 1987;9:209–15.

    CAS  Article  Google Scholar 

  14. Mancia G, Parati G, Bilo G, Gao P, Fagard R, Redon J, et al. Ambulatory blood pressare values in the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial (ONTARGET). Hypertension. 2012;60:1400–6.

    CAS  Article  Google Scholar 

  15. Burnier M, Egan BM. Adherence in hypertension. Circ Res. 2019;124:1124–40.

    CAS  Article  Google Scholar 

  16. Hamdidouche I, Julien V, Boutouyre P, Billaud E, Azizi M, Laurent S. Drug adherence in hypertension: from methodological issues to cardiovascular outcomes. J Hypertens. 2017;35:1133–44.

    CAS  Article  Google Scholar 

  17. Chobanian AV. Impact of nonadherence to antihypertensive therapy. Circulation. 2009;120:1558–60.

    Article  Google Scholar 

  18. Hill MN, Miller NH, Degeest S, Materson BJ, Black HR, Izzo JL Jr, et al. Adherence and persistence with taking medication to control high blood pressure. J Am Soc Hypertens. 2011;5:56–63.

    Article  Google Scholar 

  19. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison HC, et al. 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;71:1269–324.

    CAS  Article  Google Scholar 

  20. Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, et al. 2020 International society of hypertension global hypertension practice guidelines. J Hypertens. 2020;38:982–1004.

    CAS  Article  Google Scholar 

  21. Palatini P, Mormino P, Canali C, Santonastaso M, De Venuto G, Zanata G, et al. Factors affecting ambulatory blood pressure reproducibility. Results of the HARVEST Trial. Hypertension. 1994;23:211–6.

    CAS  Article  Google Scholar 

  22. Omboni S, Parati G, Palatini P, Vanasia A, Muiesan ML, Cuspidi C, et al. Reproducibility and clinical value of nocturnal hypotension:prospective evidence from the SAMPLE study. J Hypertens. 1998;16:733–8.

    CAS  Article  Google Scholar 

  23. Ben-Dov IZ, Ben-Arie L, Mekler J, Bursztyn M. Reproducibility of white-coat and masked hypertension in ambulatory monitoring. Int J Cardiol. 2007;117:355–9.

    Article  Google Scholar 

  24. de la Sierra A, Vinyoles E, Banegas JR, Parati G, de la Cruz JJ, Gorostidi M, et al. Short-term and long-term reproducibility of hypertension phenotypes by office and ambulatory blood pressure measurements. J Clin Hypertens. 2016;18:927–33.

    Article  Google Scholar 

  25. Hansen TW, LI Y, Boggia J, Thijs L, Richard T, Staessen J. Predictive role of the nighttime blood pressure. Hypertension. 2011;57:3–10.

    CAS  Article  Google Scholar 

  26. Salles GF, Reboldi G, Fagard RH, Cardoso CRL, Pierdomenico SD, Verdecchia P, et al. Prognostic effect of the nocturnal blood pressure fall in hypertensive patients. Hypertension. 2016;67:693–700.

    CAS  Article  Google Scholar 

  27. Kario K, Hoshide S, Mizuno H, Kabutoya T, Nishizawa M, Yoshida T, et al. Nightime blood pressure phenotype and cardiovascular prognosis. Circulation. 2020;142:1810–20.

    CAS  Article  Google Scholar 

  28. Di Rienzo M, Grassi G, Pedotti A, Mancia G. Continuous versus intermittent blood pressure measurements in estimating 24-hour average blood pressure. Hypertension. 1983;5:264–9.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Giuseppe Mancia.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mancia, G., Facchetti, R., Vanoli, J. et al. Reproducibility of blood pressure phenotypes identified by office and ambulatory blood pressure in treated hypertensive patients. Data from the PHYLLIS study. Hypertens Res 45, 1599–1608 (2022).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Hypertensive phenotypes
  • Nighttime blood pressure
  • Dipping; Reproducibility


Quick links