Portal de Periódicos da CAPES

Prevalence of Masked Hypertension in Untreated and Treated Patients With Office Blood Pressure Below 130/80 mm Hg

2018; Lippincott Williams & Wilkins; Volume: 137; Issue: 24 Linguagem: Inglês

10.1161/circulationaha.118.034619

1524-4539

Alejandro de la Sierra, José R. Banegas, Ernest Vinyoles, J. Segura, Manuel Gorostidi, Juan J. de la Cruz, Luís M. Ruilope,

Heart Rate Variability and Autonomic Control

HomeCirculationVol. 137, No. 24Prevalence of Masked Hypertension in Untreated and Treated Patients With Office Blood Pressure Below 130/80 mm Hg Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBPrevalence of Masked Hypertension in Untreated and Treated Patients With Office Blood Pressure Below 130/80 mm Hg Alejandro de la Sierra, MD, PhD, José R. Banegas, MD, PhD, Ernest Vinyoles, MD, PhD, Julián Segura, MD, PhD, Manuel Gorostidi, MD, PhD, Juan J. de la Cruz, MSc and Luis M. Ruilope, MD, PhD Alejandro de la SierraAlejandro de la Sierra Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Terrassa, Spain (A.d.l.S.). , José R. BanegasJosé R. Banegas Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, IdiPAZ and CIBERESP, Spain (J.R.B., J.J.d.l.C., L.M.R.). , Ernest VinyolesErnest Vinyoles Primary Care Centre "La Mina," Barcelona, Spain (E.V.). , Julián SeguraJulián Segura Hypertension Unit and Cardiorenal Translational Laboratory, Hospital 12 de Octubre, Madrid, Spain (J.S., L.M.R.). , Manuel GorostidiManuel Gorostidi Department of Nephrology, Hospital Universitario Central de Asturias, RedinRen, Oviedo, Spain (M.G.). , Juan J. de la CruzJuan J. de la Cruz Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, IdiPAZ and CIBERESP, Spain (J.R.B., J.J.d.l.C., L.M.R.). and Luis M. RuilopeLuis M. Ruilope Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, IdiPAZ and CIBERESP, Spain (J.R.B., J.J.d.l.C., L.M.R.). Hypertension Unit and Cardiorenal Translational Laboratory, Hospital 12 de Octubre, Madrid, Spain (J.S., L.M.R.). School of Doctoral Studies and Research, Universidad Europea, Madrid, Spain (L.M.R.). Originally published30 Apr 2018https://doi.org/10.1161/CIRCULATIONAHA.118.034619Circulation. 2018;137:2651–2653Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: June 12, 2018: Previous Version 1 The recently released American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guidelines1 proposed new values for defining hypertension: office blood pressure (BP) ≥130 systolic or ≥80 mm Hg diastolic. Furthermore, BP goals for hypertensive patients under pharmacological treatment have been recommended <130/80 mm Hg. New BP limits for office BP have been extended to define corresponding normal values for ambulatory BP monitoring (ABPM). Values of 125/75 mm Hg, 130/80 mm Hg, and 110/65 mm Hg have been proposed for 24-hour, daytime, and nighttime periods corresponding to the office cut-off of 130/80 mm Hg.1The same guideline has introduced the recommendation of using out-of-office BP measurements for both confirmation of hypertension diagnosis and for titration of antihypertensive drugs.1 Specific recommendations include the screening of masked hypertension (MH) in untreated patients with office systolic BP 120 to 129 mm Hg or office diastolic BP 75 to 79 mm Hg, and the surveillance for masked uncontrolled hypertension (MUCH) in treated patients with office BP <130/80 mm Hg if target organ damage or high cardiovascular risk is present.1In this report we sought to estimate the prevalence of MH and MUCH, defined by both the European Society of Hypertension (ESH),2 and the ACC/AHA criteria,1 in patients with office BP <130/<80 mm Hg, drawn from the Spanish ABPM Registry.This registry has recruited 115 708 patients (45 020 untreated and 70 688 treated for hypertension), from primary care centers (90%) and hypertension or cardiology clinics (10%). Mean age (SD) was 59 (14) years, 47% were women, mean body mass index was 29.8 (6.7) kg/m2, 16% were smokers, 19.8% had diabetes mellitus, and 8.6% had prevalent cardiovascular disease. Office BP was <130/<80 mm Hg in 3477 untreated patients (7.7%) and 5934 treated patients (8.4%). The registry was approved by institutional review boards of the contributing centers. Written informed consent was obtained from participants.BP was measured at the office with validated oscillometric devices after 5 minutes of rest while seated, using standardized procedures. BP values were estimated as the mean of 2 readings. Thereafter, 24-hour ABPM was performed using the SpaceLabs 90207 automated noninvasive oscillometric device, programmed to register BP at 20- and 30-minute intervals during the day and night, respectively. Valid registries had to fulfill a series of pre-established criteria, including successful recording of ≥70% of systolic BP and diastolic BP during both daytime and nighttime periods, 24-hour duration, and ≥1 BP measurement per hour. Daytime and nighttime periods were defined individually according to the patient self-reported data of going-to-bed and getting-up times.Eight different estimations of the prevalence of MH (untreated) and MUCH (treated) in patients with office BP <130/80 mm Hg were used. According to the ESH recommendations,2 prevalence was estimated by considering patients having mean 24- hour BP ≥130 or ≥80 mm Hg, mean daytime BP ≥135 or ≥85 mm Hg, mean nighttime BP ≥120 or ≥70 mm Hg, or any of the above. In addition, according to the ACC/AHA hypertension guidelines,1 MH and MUCH prevalences were estimated by considering patients with mean 24-hour BP ≥125 or ≥75 mm Hg, mean daytime BP ≥130 or ≥80 mm Hg, mean nighttime BP ≥110 or ≥65 mm Hg, or any of the above.The Table shows prevalence of MH and MUCH according to different ABPM- derived cut-off values. Prevalence estimates ranged from 14% to 66%, being 2-fold higher under ACC/AHA criteria than under ESH criteria. Using mean daytime BP, prevalence was 14% to 15% with the ESH criteria,2 and 28% to 30% with those proposed by the ACC/AHA guidelines.1 Corresponding figures by using mean 24-hour BP were 20% and 39%, respectively. When compared with patients with both normal office and ambulatory BP, MH or MUCH was associated with a worse cardiovascular risk profile, being older, more frequently males and smokers, with higher office systolic BP, and more frequently had prevalent cardiovascular disease (data not shown), in accordance with a previous report of our group.3The current data show that the proportion of MH or MUCH in patients with office BP <130/80 mm Hg is doubled when the criteria recommended by the ACC/AHA guidelines1 are applied, compared with ESH criteria2 independently of which circadian period is used for definition. We believe that confirmation of the importance of such phenotyping will require demonstration of its association with adverse cardiovascular outcomes. In this view, a recent study in blacks reported outcome-derived ABPM thresholds that were higher than those proposed by the ACC/AHA.4We have also shown that the use of the mean 24-hour BP criterion in contrast with mean daytime BP also increases the prevalence estimates of MH or MUCH. However, daytime BP is more affected by the white-coat effect. In contrast, mean 24- hour BP is the most reproducible ABPM-derived estimate and contains important prognostic information derived from nighttime BP,5 being possibly the preferred estimate for the definition of hypertension phenotypes. The high prevalence of masked hypertension observed here, in untreated and treated individuals with normal BP in the office, supports a wider use of ABPM in routine clinical practice.Table. Prevalence of Masked Hypertension in 3477 Untreated Patients and Masked Uncontrolled Hypertension in 5934 Patients Under Antihypertensive Treatment With Office Blood Pressure <130/<80 mm Hg Using Different Ambulatory Blood Pressure Monitoring-Derived LimitsPrevalence of Masked Hypertension, n (%) (N=3477)Prevalence of Masked Uncontrolled Hypertension, n (%) (N=5934)European Society of Hypertension proposed criteria Mean daytime BP ≥ 135 or 85 mm Hg497 (14.3)881 (14.8) Mean 24-h BP ≥ 130 or 80 mm Hg671 (19.3)1204 (20.3) Mean nighttime BP ≥ 120 or 70 mm Hg977 (28.1)2149 (36.2) Any of the above1147 (33.0)2349 (39.6)American College of Cardiology/American Heart Association proposed criteria Mean daytime BP ≥ 130 or 80 mm Hg1033 (29.7)1682 (28.3) Mean 24-h BP ≥ 125 or 75 mm Hg1337 (38.5)2302 (38.8) Mean nighttime BP ≥ 110 or 65 mm Hg1919 (55.2)3730 (62.9) Any of the above2094 (60.2)3956 (66.7)BP indicates blood pressure.Sources of FundingThe Spanish ABPM Registry was initiated and is maintained by an unrestricted grant from Lacer Laboratories, Spain and the Spanish Society of Hypertension. Additional funding has been obtained from the Instituto de Salud Carlos III (PI10/01011).DisclosuresNone.Footnoteshttp://circ.ahajournals.orgData sharing: For patient privacy, the clinical data and study materials will not be made available to other researchers for purposes of reproducing the results.Alejandro de la Sierra, Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Plaza Dr. Robert, 5, 08221-Terrassa, Spain. E-mail [email protected]References1. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Williamson JD, Wright JT. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Hypertension. 2018; 71:e13–e115. doi: 10.1161/HYP.0000000000000065.LinkGoogle Scholar2. O'Brien E, Parati G, Stergiou G, Asmar R, Beilin L, Bilo G, Clement D, de la Sierra A, de Leeuw P, Dolan E, Fagard R, Graves J, Head GA, Imai Y, Kario K, Lurbe E, Mallion JM, Mancia G, Mengden T, Myers M, Ogedegbe G, Ohkubo T, Omboni S, Palatini P, Redon J, Ruilope LM, Shennan A, Staessen JA, vanMontfrans G, Verdecchia P, Waeber B, Wang J, Zanchetti A, Zhang Y; European Society of Hypertension Working Group on Blood Pressure Monitoring. European Society of Hypertension position paper on ambulatory blood pressure monitoring.J Hypertens. 2013; 31:1731–1768. doi: 10.1097/HJH.0b013e328363e964.CrossrefMedlineGoogle Scholar3. Banegas JR, Ruilope LM, de la Sierra A, de la Cruz JJ, Gorostidi M, Segura J, Martell N, García-Puig J, Deanfield J, Williams B. High prevalence of masked uncontrolled hypertension in people with treated hypertension.Eur Heart J. 2014; 35:3304–3312. doi: 10.1093/eurheartj/ehu016.CrossrefMedlineGoogle Scholar4. Ravenell J, Shimbo D, Booth JN, Sarpong DF, Agyemang C, Beatty Moody DL, Abdalla M, Spruill TM, Shallcross AJ, Bress AP, Muntner P, Ogedegbe G. Thresholds for ambulatory blood pressure among African Americans in the Jackson Heart Study.Circulation. 2017; 135:2470–2480. doi: 10.1161/CIRCULATIONAHA.116.027051.LinkGoogle Scholar5. De la Sierra A, Banegas JR, Segura J, Gorostidi M, Ruilope LM. Ambulatory blood pressure monitoring and development of cardiovascular events in high- risk patients included in the Spanish ABPM Registry.J Hypertens. 2012; 30:713–719.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Shalimova A (2022) INSUFFICIENT CONTROL OF OUT-OF-OFFICE BLOOD PRESSURE: THE PROBLEM OF MASKED UNCONTROLLED HYPERTENSION: review, Inter Collegas, 10.35339/ic.8.4.201-210, 8:4, (201-210) Yano Y, Poudel B, Chen L, Sakhuja S, Jaeger B, Viera A, Shimbo D, Clark D, Anstey D, Lin F, Lewis C, Shikany J, Rana J, Correa A, Lloyd-Jones D, Schwartz J and Muntner P (2022) Impact of Asleep and 24-Hour Blood Pressure Data on the Prevalence of Masked Hypertension by Race/Ethnicity, American Journal of Hypertension, 10.1093/ajh/hpac027 Lin Y, Lampa E, Fall T, Engström G and Sundström J (2021) Blood pressure phenotypes based on ambulatory monitoring in a general middle-aged population, Blood Pressure, 10.1080/08037051.2021.1903302, 30:4, (237-249), Online publication date: 4-Jul-2021. Siddiqui M, Judd E, Zhang B, Dudenbostel T, Carey R, Oparil S and Calhoun D (2020) Masked Uncontrolled Hypertension Is Accompanied by Increased Out-of-Clinic Aldosterone Secretion, Hypertension, 77:2, (435-444), Online publication date: 1-Feb-2021. de la Sierra A, Mateu A, Gorostidi M, Vinyoles E, Segura J and Ruilope L (2020) Antihypertensive therapy and short-term blood pressure variability, Journal of Hypertension, 10.1097/HJH.0000000000002618, 39:2, (349-355), Online publication date: 1-Feb-2021. Ivy J and Bailey M (2021) Nondipping Blood Pressure: Predictive or Reactive Failure of Renal Sodium Handling?, Physiology, 10.1152/physiol.00024.2020, 36:1, (21-34), Online publication date: 1-Jan-2021. Rønningen P, Berge T, Solberg M, Enger S, Nygård S, Pervez M, Orstad E, Kvisvik B, Aagaard E, Røsjø H, Tveit A and Steine K (2020) Sex differences and higher upper normal limits for left atrial end-systolic volume in individuals in their mid-60s: data from the ACE 1950 Study, European Heart Journal - Cardiovascular Imaging, 10.1093/ehjci/jeaa004, 21:5, (501-507), Online publication date: 1-May-2020. Joshipura K, Muñoz-Torres F, Fernández-Santiago J, Patel R and Lopez-Candales A (2019) Over-the-counter mouthwash use, nitric oxide and hypertension risk, Blood Pressure, 10.1080/08037051.2019.1680270, 29:2, (103-112), Online publication date: 3-Mar-2020. de la Sierra A, Banegas J, Bursztyn M, Parati G, Stergiou G, Mateu A, Vinyoles E, Segura J, Gorostidi M and Ruilope L (2020) Prognostic Relevance of Short-Term Blood Pressure Variability, Hypertension, 0:1, Online publication date: 27-Jan-2020. de la Sierra A (2019) New American and European Hypertension Guidelines, Reconciling the Differences, Cardiology and Therapy, 10.1007/s40119-019-0144-3, 8:2, (157-166), Online publication date: 1-Dec-2019. Gijón-Conde T, Gorostidi M, Banegas J, de la Sierra A, Segura J, Vinyoles E, Divisón-Garrote J and Ruilope L (2019) Documento de la Sociedad Española de Hipertensión-Liga Española para la Lucha contra la Hipertensión Arterial (SEH-LELHA) sobre monitorización ambulatoria de la presión arterial (MAPA) 2019, Hipertensión y Riesgo Vascular, 10.1016/j.hipert.2019.05.002, 36:4, (199-212), Online publication date: 1-Oct-2019. Dzau V and Balatbat C (2019) Future of Hypertension, Hypertension, 74:3, (450-457), Online publication date: 1-Sep-2019.Siddiqui M, Judd E, Dudenbostel T, Zhang B, Gupta P, Tomaszewski M, Patel P, Oparil S and Calhoun D (2019) Masked Uncontrolled Hypertension Is Not Attributable to Medication Nonadherence, Hypertension, 74:3, (652-659), Online publication date: 1-Sep-2019.Booth J, Hubbard D, Sakhuja S, Yano Y, Whelton P, Wright J, Shimbo D and Muntner P (2019) Proportion of US Adults Recommended Out-of-Clinic Blood Pressure Monitoring According to the 2017 Hypertension Clinical Practice Guidelines, Hypertension, 74:2, (399-406), Online publication date: 1-Aug-2019. Pallarés-Carratalá V, Bonig-Trigueros I, Palazón-Bru A, Esteban-Giner M, Gil-Guillén V and Giner-Galvañ V (2019) Clinical inertia in hypertension: a new holistic and practical concept within the cardiovascular continuum and clinical care process , Blood Pressure, 10.1080/08037051.2019.1608134, 28:4, (217-228), Online publication date: 4-Jul-2019. Ruilope L, Ruiz-Hurtado G, Barderas M, de la Cruz J, Lucia A, de la Sierra A, Gorostidi M, Vinyoles E, Segura J, Solís J, Arribas F, García-Puig J, Tamargo J, O'Brien E, Volpe M, Whelton P, Williams B and Banegas J (2019) Frequency and Prognosis of Treated Hypertensive Patients According to Prior and New Blood Pressure Goals, Hypertension, 74:1, (130-136), Online publication date: 1-Jul-2019. Erina A, Rotar O, Solntsev V, Shalnova S, Deev A, Baranova E, Konradi O, Boytsov S and Shlyakhto E (2019) Epidemiology of Arterial Hypertension in Russian Federation – Importance of Choice of Criteria of Diagnosis, Kardiologiia, 10.18087/cardio.2019.6.2595, 59:6, (5-11) Byrd J and Brook R (2019) Hypertension, Annals of Internal Medicine, 10.7326/AITC201905070, 170:9, (ITC65), Online publication date: 7-May-2019. Koletsos N, Dipla K, Triantafyllou A, Gkaliagkousi E, Sachpekidis V, Zafeiridis A and Douma S (2019) A brief submaximal isometric exercise test 'unmasks' systolic and diastolic masked hypertension, Journal of Hypertension, 10.1097/HJH.0000000000001943, 37:4, (710-719), Online publication date: 1-Apr-2019. Kario K, Thijs L and Staessen J (2019) Blood Pressure Measurement and Treatment Decisions, Circulation Research, 124:7, (990-1008), Online publication date: 29-Mar-2019. Cuspidi C, Sala C, Tadic M and Grassi G (2018) When Office Blood Pressure Is Not Enough: The Case of Masked Hypertension, American Journal of Hypertension, 10.1093/ajh/hpy183, 32:3, (225-233), Online publication date: 12-Feb-2019. Segura J (2019) Patient with Masked Hypertension Hypertension and 24-hour Ambulatory Blood Pressure Monitoring, 10.1007/978-3-030-02741-4_2, (11-21), . López-Candales A (2018) Beyond the new blood pressure guidelines: the beat goes on, Postgraduate Medicine, 10.1080/00325481.2018.1526624, 130:8, (666-668), Online publication date: 17-Nov-2018. Melville S and Byrd J (2018) Out-of-Office Blood Pressure Monitoring in 2018, JAMA, 10.1001/jama.2018.14865, 320:17, (1805), Online publication date: 6-Nov-2018. Polonsky T and Bakris G (2018) Ambulatory Blood Pressure Monitoring, JAMA, 10.1001/jama.2018.14856, 320:17, (1807), Online publication date: 6-Nov-2018. Gorostidi M and de la Sierra A (2018) Combination therapies for hypertension – why we need to look beyond RAS blockers, Expert Review of Clinical Pharmacology, 10.1080/17512433.2018.1509705, 11:9, (841-853), Online publication date: 2-Sep-2018. Piskorz D (2018) Ethnicity and Left Ventricular Hypertrophy: Tools and Uncertainties, High Blood Pressure & Cardiovascular Prevention, 10.1007/s40292-018-0271-2, 25:3, (291-294), Online publication date: 1-Sep-2018. June 12, 2018Vol 137, Issue 24 Advertisement Article InformationMetrics © 2018 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.118.034619PMID: 29712713 Originally publishedApril 30, 2018 Keywordsmasked hypertensionPDF download Advertisement SubjectsHigh Blood PressureHypertension