CORRESPONDENCE: LETTER TO THE EDITOR
Masked Hypertension and White-Coat Hypertension Prognosis
Willem Verberk, MSc*,
Abraham A. Kroon, MD and
Peter W. de Leeuw, MD, PhD
* Department of Internal Medicine, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands (Email: willem.verberk{at}carim.unimaas.nl).
The recent published study by Ohkubo et al. (1) investigated the interesting relationship between masked hypertension and the risk of cardiovascular mortality and morbidity in the future. This 10-year follow-up study demonstrated that the relative hazards of masked hypertensive patients and sustained hypertensive patients were significantly higher than the hazards for white-coat hypertensive patients and patients with normal blood pressure (BP).
However, there are some limitations that deserve special attention. The BP level may have been decreased coincidently during the single-office BP measurement owing to BP variability. In addition, one-third of the subjects classified as masked hypertensive received antihypertensive treatment and may have taken their medication a few hours before the visit, leading to decreased BP levels at the time of measurement. When these drugs have a short half-life and/or patients have a poor adherence to the prescribed medication, BP may be higher outside the office, causing a classification of masked hypertension.
Thus, this indicates that the subjects who are classified as masked hypertensive are in fact true hypertensives, as is confirmed by their ambulatory BP value, which is considered to be more reliable than conventional office BP measurements (2).
Although no statistical difference was given between relative hazards for sustained and masked hypertension, a potential reason that subjects classified as masked hypertensive had a lower risk of cardiovascular morbidity than did those classified as sustained hypertensive may be explained by the fact that the chance of being classified as masked hypertensive is higher for mild to moderate hypertensive patients than it is for severe hypertensive patients because their BP values are closer to the upper limits.
Therefore, we conclude that masked hypertension is an erroneous description of sustained hypertension.
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1. Ohkubo T, Kikuya M, Metoki H, et al. 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.[Abstract/Free Full Text]2. Verdecchia P, Reboldi G, Porcellati C, et al. Risk of cardiovascular disease in relation to achieved office and ambulatory blood pressure control in treated hypertensive subjects J Am Coll Cardiol 2002;39:878-885.[Abstract/Free Full Text]
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