CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Takayoshi Ohkubo, MD*,
Masahiro Kikuya, MD, PhD,
Hirohito Metoki, MD,
Kei Asayama, MD,
Taku Obara, MS,
Junichiro Hashimoto, MD, PhD,
Kazuhito Totsune, MD, PhD,
Haruhisa Hoshi, MD, PhD,
Hiroshi Satoh, MD, PhD and
Yutaka Imai, MD, PhD
* Department of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Science, 1-1 Seiryo-cho, Aoba-ku, Sendai, 980-8574, Japan (Email: tohkubo{at}mail.tains.tohoku.ac.jp).
We appreciate the comments by Verberk and colleagues regarding our recent study (1). We agree with their comments that blood pressure (BP) level may have been decreased coincidently at the single-office BP measurement occasion due to BP variability. That is exactly the nature of "casual" office BP.
As Verberk and colleagues correctly pointed out, one-third of our study subjects who were classified as masked hypertension received antihypertensive treatment (1). Baseline proportion of those with antihypertensive treatment was higher in subjects with masked hypertension than in those with sustained normal BP (1). Antihypertensive treatment is an established cause of masked hypertension, especially when office BP is measured a few hours after antihypertensive drugs are taken (2). The use of two or more antihypertensive drugs also increases the odds of masked hypertension compared with the monotherapy in treated hypertensive patients (3).
As well as subjects with sustained hypertension, those who are classified as masked hypertension are in fact "true" hypertensives in terms of their cardiovascular risks. There was no significant difference between relative hazards for sustained and masked hypertension (p > 0.3 for all primary and secondary outcomes). The most important factor is that masked hypertension may not be identified by "casual" office BP measurement, which is usually "causal" in the worst sense of the word (4). Use of ambulatory BP monitoring or self-measured home BP can identify masked hypertension. Physicians/health practitioners should recognize at least the possibility that office BP measurements would miss masked hypertension. Nevertheless, they do not take into account the possibility of masked hypertension should the patients develop organ damage/cardiovascular diseases despite good control of office BP and other risk factors. If these patients are not identified and do not receive appropriate treatment, they could develop further organ damage/cardiovascular diseases.
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References
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- 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]
- Pickering TG, Davidson K, Gerin W, et al. Masked hypertension Hypertension 2002;40:795-796.[Free Full Text]
- Obara T, Ohkubo T, Funahashi J, et al. Isolated uncontrolled hypertension at home and in the office among treated hypertensive patients from the J-HOME study J Hypertens 2005;23:1653-1660.[Medline]
- Graves JW, Sheps SG. Does evidence-based medicine suggest that physicians should not be measuring blood pressure in the hypertensive patient? Am J Hypertens 2004;17:354-360.[CrossRef][Medline]
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