Long-Term Stroke Risk Due to Partial White-Coat or Masked Hypertension Based on Home and Ambulatory Blood Pressure Measurements: The Ohasama Study

Michihiro Satoh, Kei Asayama, Masahiro Kikuya, Ryusuke Inoue, Hirohito Metoki, Miki Hosaka, Megumi Tsubota-Utsugi, Taku Obara, Aya Ishiguro, Keiko Murakami, Ayako Matsuda, Daisaku Yasui, Takahisa Murakami, Nariyasu Mano, Yutaka Imai, Takayoshi Ohkubo

Research output: Contribution to journalArticlepeer-review

43 Citations (Scopus)

Abstract

The prognostic significance of white-coat hypertension (WCHT) is controversial, and different findings on self-measured home measurements and 24-h ambulatory monitoring make identifying WCHT difficult. We examined whether individuals with partially or completely defined WCHT, as well as masked hypertension, as determined by different out-of-office blood pressure measurements, have a distinct long-term stroke risk. We followed 1464 participants (31.8% men; mean age, 60.6±10.8 years) in the general population of Ohasama, Japan, for a median of 17.1 years. A first stroke occurred in 212 subjects. Using sustained normal blood pressure (events/n=61/776) as a reference, adjusted hazard ratios for stroke (95% confidence intervals; events/n) were 1.38 (0.82-2.32; 19/137) for complete WCHT (isolated office hypertension), 2.16 (1.36-3.43; 29/117) for partial WCHT (either home or ambulatory normotension with office hypertension), 2.05 (1.24-3.41; 23/100) for complete masked hypertension (both home and ambulatory hypertension with office normotension), 2.08 (1.37-3.16; 38/180) for partial masked hypertension (either home or ambulatory hypertension with office normotension), and 2.46 (1.61-3.77; 42/154) for sustained hypertension. When partial WCHT and partial masked hypertension groups were further divided into participants only with home hypertension and those only with ambulatory hypertension, all subgroups had a significantly higher stroke risk (adjusted hazard ratio ≥1.84, P≤0.04). In conclusion, impacts of partial WCHT as well as partial masked hypertension for long-term stroke risk were comparable to those of complete masked hypertension or sustained hypertension. We need both home and 24-h ambulatory blood pressure measurements to evaluate stroke risk accurately.

Original languageEnglish
Pages (from-to)48-55
Number of pages8
JournalHypertension
Volume67
Issue number1
DOIs
Publication statusPublished - 2016 Jan 1

Keywords

  • blood pressure
  • epidemiology
  • hypertension
  • population
  • stroke

ASJC Scopus subject areas

  • Internal Medicine

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