Published online before print November 4, 2002, doi: 10.1161/01.HYP.0000038733.08436.98
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(Hypertension. 2002;40:795.)
© 2002 American Heart Association, Inc.
Editorial Commentaries |
Masked Hypertension
From the Zena & Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center (T.G.P., K.D., W.G.), New York, NY ; and the Department of Psychiatry and Behavioral Science, State University of New York at Stony Brook (J.E.S.), New York, NY.
Correspondence to Dr Thomas G. Pickering, Zena & Michael A Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, NY 10029–6574. E-mail Thomas.Pickering@msnyu health.org
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
The addition of ambulatory blood pressure monitoring to conventional clinic measurement for defining blood pressure status in clinical practice has added a new complexity to the process, because the separation of normotension and hypertension can be assessed independently by each of the 2 methods. We thus have 4 potential groups of patients who are, first, normotensive by both methods (true normotensives); second, hypertensive by both (true, or sustained, hypertensives); third, hypertensive by clinic measurement and normotensive by ambulatory measurement (white-coat hypertensives); and, fourth, normotensive by clinic measurement and hypertensive by ambulatory measurement. From a clinical point of view, the first 2 groups are easy to deal with, because both methods give the same classification. Of more interest are the groups in which there is disagreement. The third group, usually referred to as white-coat hypertensives, or less frequently, as isolated office hypertensives, have been extensively studied and are generally accepted as being at relatively low risk of cardiovascular morbidity,1 a view consistent with the concept that ambulatory pressure gives a better prediction of risk than clinic pressure.
Until now, little attention has been given to the fourth group, whose condition has been given the awkward titles of "reverse white-coat hypertension" or "white-coat normotension." If it is true that the ambulatory pressure gives the better classification of risk, it would imply that these people should be regarded as being genuinely hypertensive, as argued below. We also propose that the phenomenon might be called "masked hypertension," on the grounds that the hypertension is
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