Abstract 409: Reproducibility of White Coat and Masked Hypertension Definitions One Year after the Diagnosis
A significant number of subjects present discordant results when BP is measured both at the clinic and by 24-hour ABPM. The aim of the study was to assess the reproducibility of a diagnosis of normotension (NT), white coat hypertension (WCH), masked hypertension (MH) and sustained hypertension (SH) in a cohort of untreated subjects who underwent a second ABPM without being treated with antihypertensive drugs.
From the Spanish ABPM Registry, we selected 843 untreated subjects who underwent at least 2 BP examinations (both at the clinic and by ABPM) separated by 2 months or more (median,IQR: 13; 6-28 months), and who did not receive antihypertensive drug treatment in the period lasting between the 2 examinations. The 4 above mentioned categories were defined by normal (<140/90 mmHg) or elevated BP at the clinic (mean of 2 measurements), and by normal (<130/80 mmHg) or elevated 24-hour BP.
At baseline, 140 (17%), 206 (25%), 78 (9%), and 414 (49%) had NT, WCH, MH, and SH, respectively. At the 2nd clinic and ABPM examination 52% of NT, 55% of WCH, 47% of MH, and 82% of SH fall into the same category. In both the WCH and MH categories, the most frequent switch was to SH (26% and 33%, respectively). When patients who changed or remained in the same category were compared, there were no differences in clinical variables, such as age, gender, or prevalence of obesity, diabetes, or previous cardiovascular disease. Both clinic and ambulatory BP were higher in patients who fall into the same category in both examinations, but this was driven by the higher reproducibility of SH. In the specific group of WCH (206 patients) there were no significant BP differences at baseline between the 114 who maintained such diagnosis, compared to the 54 patients who developed SH. Conversely, in the 78 patients with MH at baseline, those who developed SH at the 2nd examination (26) had higher levels of clinic diastolic BP (84±4 vs. 80±5 mmHg; p=0.006), compared with those who remained with MH (37).
In conclusion, the diagnosis of SH is highly reproducible after one year of the first diagnosis. However, a diagnosis of WCH or MH requires a close follow-up, as almost 50% of patients do not show the same diagnosis and develop SH. There is no a specific clinical pattern which can be of help to predict which patients will develop SH.
Author Disclosures: A. De la sierra: None. J.R. Banegas: None. E. Vinyoles: None. M. Gorostidi: None. J. Segura: None. J.J. De la cruz: None. L.M. Ruilope: None.
- © 2014 by American Heart Association, Inc.