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(Hypertension. 2007;49:e25.)
© 2007 American Heart Association, Inc.

Letters to the Editor

Is Siesta Masking Masked Hypertension?

Iddo Z. Ben-Dov

Nephrology and Hypertension Services, Hadassah–Hebrew University Medical Center, Jerusalem, Israel

Michael Bursztyn

Internal Medicine Department, Mount-Scopus Campus, Hadassah–Hebrew University Medical Center, Jerusalem, Israel

To the Editor:

Banegas et al,¹ for the Spanish Society of Hypertension Ambulatory Blood Pressure Monitoring Registry Investigators, have examined the sensitivity and specificity of office blood pressure measurements in assessing control of hypertension in treated patients. The "gold standard" reference was the daytime component of a 24-hour ambulatory blood pressure monitoring. In this manner, 33.4% had a false-positive office blood pressure measurement (the equivalent of white-coat hypertension in nontreated patients), whereas only 5.4% had a false-negative result (corresponding with masked hypertension). Thus, underestimation of BP control by office measurements was clearly more prevalent than overestimation. This differs from the findings in general,² hypertensive,³ and referred⁴ populations, in whom white-coat hypertension and masked hypertension have rather similar prevalence (10% to 20% each entity). The impression is that treated Spanish participants’ control rates are better than those considered previously.

A possible explanation for this encouraging finding would be a preferential effect of treatment on ambulatory blood pressure, as opposed to clinic blood pressure. However, another possibility that requires consideration is that the gold standard reference was inadequate. First, defining normal ambulatory blood pressure according to daytime (awake state) measurements alone may misclassify 4% of the patients as controlled, whereas, in fact, their 24-hour blood pressure is abnormal.⁵

Second, to be valid, the daytime blood pressure average used to judge ambulatory blood pressure normality must only include measurements taken in the awake state. Had values recorded during daytime napping (namely, siesta) been included with the awake measurements, they would falsely lower these averages, thus erroneously presenting high rates of daytime ambulatory blood pressure control. Perhaps a way to overcome both issues, before endorsing the encouraging message of Banegas et al,¹ is to use 24-hour blood pressure normality as the gold standard reference.

	Acknowledgments

 
Disclosures

None.

	References

Top References

 

1. Banegas JR, Segura J, Sobrino J, Rodriguez-Artalejo F, de la SA, de la Cruz JJ, Gorostidi M, Sarria A, Ruilope LM. Effectiveness of blood pressure control outside the medical setting. Hypertension. 2007; 49: 62–68.[Abstract/Free Full Text]
2. Sega R, Trocino G, Lanzarotti A, Carugo S, Cesana G, Schiavina R, Valagussa F, Bombelli M, Giannattasio C, Zanchetti A, Mancia G. Alterations of cardiac structure in patients with isolated office, ambulatory, or home hypertension: data from the general population (Pressione Arteriose Monitorate E Loro Associazioni [PAMELA] Study). Circulation. 2001; 104: 1385–1392.[Abstract/Free Full Text]
3. Wing LM, Brown MA, Beilin LJ, Ryan P, Reid CM. ‘Reverse white-coat hypertension’ in older hypertensives. J Hypertens. 2002; 20: 639–644.[CrossRef][Medline] [Order article via Infotrieve]
4. Ben Dov IZ, Ben Arie L, Mekler J, Bursztyn M. In clinical practice, masked hypertension is as common as isolated clinic hypertension: predominance of younger men. Am J Hypertens. 2005; 18: 589–593.[CrossRef][Medline] [Order article via Infotrieve]
5. Ben Dov IZ, Ben Arie L, Mekler J, Bursztyn M. Normal ambulatory blood pressure: a clinical-practice-based analysis of recent Am Heart Association recommendations. Am J Med. 2006; 119: 69.e13–e18.

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This Article Extract Full Text (PDF) All Versions of this Article: 49/4/e25    most recent 01.HYP.0000258797.25373.20v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ben-Dov, I. Z. Articles by Bursztyn, M. Search for Related Content PubMed PubMed Citation Articles by Ben-Dov, I. Z. Articles by Bursztyn, M. Related Collections Other hypertension