White-coat effect and masked hypertension in patients with high-normal office blood pressure: results of the Hungarian ABPM Registry

János Nemcsik, Johanna Takács, Zsófia Kekk, Csaba Farsang, Attila Simon, Dénes Páll, Péter Torzsa, Szilveszter Dolgos, Ákos Koller, Dorottya Pásztor, Zoltán Járai

Keywords: high-normal blood pressure, white-coat effect, masked hypertension, ambulatory blood pressure monitoring

Background:

The initiation of antihypertensive medication is already recommended in patients with very high cardiovascular (CV) risk and high-normal office blood pressure (OBP). However, white-coat effect can be present in this BP category as well.

Research questions:

The aims of this study were to evaluate the presence of white-coat effect and masked hypertension in high-normal OBP and to explore the prevalence of untreated very high CV risk patients in this BP category.

Method:

Data of the Hungarian ABPM Registry were used in our analysis.

Results:

From 38720 uploaded ABPM curves with clinical data 9657 subjects were categorized as having high-normal OBP. Among those, 7218 (74.7%) were on antihypertensive treatment. Based on the ABPM recordings high-normal BP was confirmed in 14.3% (n=1365), while white-coat effect was present in 11.1% (n=1038) and masked hypertension in 74.6% (n=7204). Similar results were found in treated and untreated subjects as well. Independent predictors of white-coat effect were age (OR:1.01 (95%CI:1.004-1.01), p<0.001), female sex (OR:1.41 (1.18-1.68), p<0.001), obesity (OR:0.76 (0.61-0.95), p<0.001) and very high CV risk (OR:1.30 (95%CI:1.01-1.67, p<0.001). Independent predictors of masked hypertension were male sex (OR:1.92 (95% CI:1.70-2.17), p<0.001) and obesity (OR:1.55 (1.33-1.80), p<0.001). 1021 subjects had very high CV risk with high-normal OBP and only 45 of them were untreated. With ABPM only 6 (13%) of them had confirmed high-normal BP, but 34 (75%) of them had MH.

Conclusions:

In high-normal OBP, ABPM is a useful tool to diagnose white-coat effect and masked hypertension. Untreated high-normal OBP with very high CV risk is a very rare condition in the general practitioner practice, and most of these patients have masked hypertension.

Points for discussion:

ABPM use in general practice.

Treatment of high-normal blood pressure.

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