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Hypertension. 2014 Nov;64(5):935-42. doi: 10.1161/HYPERTENSIONAHA.114.03614. Epub 2014 Aug 18.

Setting thresholds to varying blood pressure monitoring intervals differentially affects risk estimates associated with white-coat and masked hypertension in the population.

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From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (K.A., L.T., Y.-M.G., A.H., Y.-P.L., Z.Z., F.-F.W., J.A.S.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., T.O., Y.I.); Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Y.L., F.-F.W., J.W.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (I.L., J.B., L. Luzardo); Departamento de Informática, Universidad Politécnica de Sinaloa, Mazatlán, Mexico (L.J.M.); Steno Diabetes Center, Gentofte and Research Center for Prevention and Health, Denmark (T.W.H.); Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden (K.B.-B., L. Lind); Department of Cardiology, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden (K.B.-B.); Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.N., T.O.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark (J.J.); Department of Health Science and Technology, Aalborg University, Aalborg, Denmark (C.T.-P.); Cambridge University Hospitals, Addenbrook's Hospital, Cambridge, United Kingdom (E.D.); First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.S.-S., K.K.-J.); Department of Medicine, University of Padua, Padua, Italy (E.C.); Institute of Internal Medicine, Novosibirsk, Russian Federation (S.M., Y.N.); Faculty of Medicine, Charles University, Pilsen, Czec


Outcome-driven recommendations about time intervals during which ambulatory blood pressure should be measured to diagnose white-coat or masked hypertension are lacking. We cross-classified 8237 untreated participants (mean age, 50.7 years; 48.4% women) enrolled in 12 population studies, using ≥140/≥90, ≥130/≥80, ≥135/≥85, and ≥120/≥70 mm Hg as hypertension thresholds for conventional, 24-hour, daytime, and nighttime blood pressure. White-coat hypertension was hypertension on conventional measurement with ambulatory normotension, the opposite condition being masked hypertension. Intervals used for classification of participants were daytime, nighttime, and 24 hours, first considered separately, and next combined as 24 hours plus daytime or plus nighttime, or plus both. Depending on time intervals chosen, white-coat and masked hypertension frequencies ranged from 6.3% to 12.5% and from 9.7% to 19.6%, respectively. During 91 046 person-years, 729 participants experienced a cardiovascular event. In multivariable analyses with normotension during all intervals of the day as reference, hazard ratios associated with white-coat hypertension progressively weakened considering daytime only (1.38; P=0.033), nighttime only (1.43; P=0.0074), 24 hours only (1.21; P=0.20), 24 hours plus daytime (1.24; P=0.18), 24 hours plus nighttime (1.15; P=0.39), and 24 hours plus daytime and nighttime (1.16; P=0.41). The hazard ratios comparing masked hypertension with normotension were all significant (P<0.0001), ranging from 1.76 to 2.03. In conclusion, identification of truly low-risk white-coat hypertension requires setting thresholds simultaneously to 24 hours, daytime, and nighttime blood pressure. Although any time interval suffices to diagnose masked hypertension, as proposed in current guidelines, full 24-hour recordings remain standard in clinical practice.


ambulatory blood pressure monitoring; cardiovascular risk; masked hypertension; population science; white-coat hypertension

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