Abstract
Introduction: Hypertension, with its various phenotypes including white-coat hypertension (WCHT), masked hypertension (MHT), and sustained hypertension (SHT), is a known risk factor for cardiovascular diseases (CVDs). Yet, it remains unclear whether the association between subclinical CVD and hypertension varies based on its phenotype, and if this relationship differs depending on the location of atherosclerosis. Hypothesis: We hypothesized that MHT, WCHT, and SHT are associated with greater subclinical cerebrovascular diseases and coronary artery calcification (CAC) compared to normotension. Methods: In this community-based observational study of Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA), a total of 740 male participants underwent brain magnetic resonance imaging (MRI) to assess the presence of lacunar infarction, white-matter hyperintensities (WMHs), microbleed, and intracranial artery stenosis (ICAS) between 2012 and 2015. They also underwent office blood pressure (BP) measurements, home BP monitoring for at least 5 consecutive days, and CAC assessments between 2010-2014. The final analysis included 686 participants without a history of CVDs. Results: Of the 686 participants, the mean age was 68.0 years (SD±8.3) and 39.3% were receiving antihypertensive medicine. Using a multivariable logistic regression analysis, WCHT, MHT, and SHT each were significantly associated with higher risk for microbleeds compared to the normotensive group (see Table). However, the association of WCHT with microbleeds was evident in participants on antihypertensive medication (Odds ratios 7.98, 95% confidence interval 2.10-30.24), but was absent in those not taking such medication (Odds ratios 1.23, 95% confidence interval 0.31-4.83). SHT was associated with lacunar infarction, ICAS and CAC compared to the normotensive group (see Table). Conclusions: In Japanese men, WCHT, MHT, and SHT were associated with subclinical cerebrovascular diseases, whereas only SHT was associated to CAC.
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