Clinical characteristics and prognostic factor of isolated-office hypertension in patients with hypertension therapy

Abstract

Objectives: Some patients with hypertension therapy show a white-coat effect that could cause an overestimation of their real blood pressure (BP). We evaluated the prevalence and clinical characteristics of white-coat or isolated-office hypertension (IOH) under hypertension therapy by comparing clinic BP values with either daytime home BP measurements or the awake BP mean obtained from ambulatory BP monitoring (ABPM) and evaluating of cardiovascular (CVD) event. Methods: The study evaluated 1028 patients treated with hypertension medications and evaluated by 24-h ABPM. Among the participants, classified as true IOH (elevated clinic BP and controlled awake and asleep ambulatory BPs while treated), false IOH (elevated clinic BP, controlled awake SBP/DBP means, but elevated asleep SBP or DBP mean while treated), and the controlled hypertensive patients. AMBP and pulse wave velocity (PWV), left ventricular mass index (LVMI) and plaque in carotid artery (PCA), intima-media thickness (CIMT) and urine albumin/creatinine ratio (UACR) were measured. Results: Patients with false, relative to those with true, IOCH had higher prevalence of microalbuminuria and CIMT> 0.85 mm and UACR, PCA (p<0.001), The estimated hazard ratio of CVD event, using a fully adjusted model including the significant confounding variables of sex, age, diabetes, chronic kidney disease, asleep SBP mean was significantly greater for patients with false compared with those with true IOH (2.02 [95% confidence interval: 1.95-2.32]; p<0.001). And they had an equivalent estimated hazard ratio of CVD event (1.01 [95% confidence interval: 0.97-1.12]; p=0.54). Conclusion: Our results suggest that much higher prevalence of non-dipper, false, isolated office hypertension is a significant increased CVD events compared with true IOH. The highly significant prognostic factor of isolated office hypertension might be nighttime BP. Comparison of clinic BP with either daytime home BP measurements or awake measurements by AMPM might be particularly important in isolated office uncontrolled hypertension for the early detection of CVD event.