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,,||
* Departments of Planning for Drug Development and Clinical Evaluation
Clinical Pharmacology and Therapeutics
Environmental Health Science
Tohoku University Graduate School of Pharmaceutical Science and Medicine
|| 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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