CLINICAL RESEARCH: HYPERTENSION
Prognosis of "Masked" Hypertension and "White-Coat" Hypertension Detected by 24-h Ambulatory Blood Pressure Monitoring
10-Year Follow-Up From the Ohasama Study
Takayoshi Ohkubo, MD, PhD*, ,||,*,
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 Planning for Drug Development and Clinical Evaluation, Sendai
Department of Clinical Pharmacology and Therapeutics, Sendai
Department of Environmental Health Science, Sendai
Tohoku University Graduate School of Pharmaceutical Science and Medicine, Sendai
|| Tohoku University 21st Century COE Program "Comprehensive Research and Education Center for Planning of Drug Development and Clinical Evaluation," Sendai
¶ Ohasama Hospital, Iwate, Japan
Manuscript received September 30, 2004;
revised manuscript received February 23, 2005,
accepted March 1, 2005.
* Reprint requests and correspondence: Dr. Takayoshi Ohkubo, 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).
OBJECTIVES: We sought to investigate the prognosis in subjects with "white-coat" hypertension (WCHT) and "masked" hypertension (MHT), in which blood pressure (BP) is lower in clinical measurements than during ambulatory monitoring.
BACKGROUND: The prognostic significance of WCHT remains controversial, and little is known about MHT.
METHODS: We obtained 24-h ambulatory BP and "casual" BP (i.e., obtained in clinical scenarios) values from 1,332 subjects (872 women, 460 men)  40 years old in a representative sample of the general population of a Japanese community. Survival and stroke morbidity were then followed up for a mean duration of 10 years.
RESULTS: Composite risk of cardiovascular mortality and stroke morbidity examined using a Cox proportional hazards regression model for subjects with WCHT (casual BP 140/90 mm Hg, daytime BP <135/85 mm Hg; relative hazards [RH])1.28; 95% confidence interval [CI] 0.76 to 2.14) was no different from risk for subjects with sustained normal BP (casual BP <140/90 mm Hg, daytime BP <135/85 mm Hg). However, risk was significantly higher for subjects with MHT (casual BP <140/90 mm Hg, daytime BP 135/85 mm Hg; RH 2.13; 95% CI 1.38 to 3.29) or sustained hypertension (casual BP 140/90 mm Hg, daytime BP 135/85 mm Hg; RH 2.26; 95% CI 1.49 to 3.41) than for subjects with sustained normal BP. Similar findings were observed for cardiovascular mortality and stroke morbidity among subgroups by gender, use of antihypertensive medication, and risk factor level (all p for heterogeneity >0.2).
CONCLUSIONS: Conventional BP measurements may not identify some individuals at high or low risk, but these people may be identifiable by the use of ambulatory BP.
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Abbreviations and Acronyms
| | BP = blood pressure | | CI = confidence interval | | MHT = masked hypertension | | RH = relative hazard | | SHT = sustained hypertension | | SNBP = sustained normal blood pressure | | TIA = transient ischemic attack | | WCHT = white-coat hypertension |
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