Significance of white-coat hypertension in older persons with isolated systolic hypertension: A meta-analysis using the international database on ambulatory blood pressure monitoring in relation to cardiovascular outcomes population

Stanley S. Franklin, Lutgarde Thijs, Tine W. Hansen, Yan Li, José Boggia, Masahiro Kikuya, Kristina Björklund-Bodegård, Takayoshi Ohkubo, Jørgen Jeppesen, Christian Torp-Pedersen, Eamon Dolan, Tatiana Kuznetsova, Katarzyna Stolarz-Skrzypek, Valérie Tikhonoff, Sofia Malyutina, Edoardo Casiglia, Yuri Nikitin, Lars Lind, Edgardo Sandoya, Kalina Kawecka-JaszczYutaka Imai, Jiguang Wang, Hans Ibsen, Eoin O'Brien, Jan A. Staessen

Research output: Contribution to journalArticlepeer-review

140 Citations (Scopus)

Abstract

The significance of white-coat hypertension in older persons with isolated systolic hypertension remains poorly understood. We analyzed subjects from the population-based 11-country International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes database who had daytime ambulatory blood pressure (BP; ABP) and conventional BP (CBP) measurements. After excluding persons with diastolic hypertension by CBP (90 mm Hg) or by daytime ABP (85 mm Hg), a history of cardiovascular disease, and persons <18 years of age, the present analysis totaled 7295 persons, of whom 1593 had isolated systolic hypertension. During a median follow-up of 10.6 years, there was a total of 655 fatal and nonfatal cardiovascular events. The analyses were stratified by treatment status. In untreated subjects, those with white-coat hypertension (CBP 140/<90 mm Hg and ABP <135/<85 mm Hg) and subjects with normal BP (CBP <140/<90 mm Hg and ABP <135/<85 mm Hg) were at similar risk (adjusted hazard rate: 1.17 [95% CI: 0.87-1.57]; P=0.29). Furthermore, in treated subjects with isolated systolic hypertension, the cardiovascular risk was similar in elevated conventional and normal daytime systolic BP as compared with those with normal conventional and normal daytime BPs (adjusted hazard rate: 1.10 [95% CI: 0.79-1.53]; P=0.57). However, both treated isolated systolic hypertension subjects with white-coat hypertension (adjusted hazard rate: 2.00; [95% CI: 1.43-2.79]; P<0.0001) and treated subjects with normal BP (adjusted hazard rate: 1.98 [95% CI: 1.49-2.62]; P<0.0001) were at higher risk as compared with untreated normotensive subjects. In conclusion, subjects with sustained hypertension who have their ABP normalized on antihypertensive therapy but with residual white-coat effect by CBP measurement have an entity that we have termed, "treated normalized hypertension." Therefore, one should be cautious in applying the term "white-coat hypertension" to persons receiving antihypertensive treatment.

Original languageEnglish
Pages (from-to)564-571
Number of pages8
JournalHypertension
Volume59
Issue number3
DOIs
Publication statusPublished - 2012 Mar

Keywords

  • ambulatory blood pressure
  • cardiovascular disease
  • epidemiology
  • isolated systolic hypertension
  • white-coat effect
  • white-coat hypertension

ASJC Scopus subject areas

  • Internal Medicine

Fingerprint Dive into the research topics of 'Significance of white-coat hypertension in older persons with isolated systolic hypertension: A meta-analysis using the international database on ambulatory blood pressure monitoring in relation to cardiovascular outcomes population'. Together they form a unique fingerprint.

Cite this