Abstract

Objective: Blood pressure (BP) increases in colder seasons, but the impact of outdoor temperature on BP phenotypes derived from office BP (OBP) and home BP monitoring (HBPM) is not is not completely established due to the scarcity of data. This study evaluated the relationship of outdoor temperature with normotension (NT), white-coat hypertension (WCH), masked hypertension (MH) and sustained hypertension (SH) in a large multicenter Brazilian sample. Design and method: This cross-sectional study evaluated 57,606 individuals [39% men, mean age = 57.4±15.6 years, OBP = 131.4±19.8/83.9±11.8 mmHg, HBPM = 125.0±15.8/79.4±9.6 mmHg, 51% using antihypertensive medications (AH)] from 13 cities/metropolitan regions of the 5 Brazilian regions (North, Northeast, Central-West, Southeast and South) who underwent OBP and HBPM measurements from 2018 to 2022. Data on daily outdoor mean temperature (OMT), wind velocity and atmospheric pressure, and outdoor monthly humidity were collected from meteorological stations located in the studied cities. BP phenotypes were defined as: NT (OBP<140/90mmHg and HBPM<135/85mmHg), WCH (OBP > = 140/90mmHg and HBPM<135/85mmHg), MH (OBP<140/90mmHg and HBPM> = 135/85mmHg) and SH (OBP> = 140/90mmHg and HBPM> = 135/85mmHg). All regression analyses were adjusted for age, sex, BMI, calendar time, region, AH use and city altitude, wind velocity, atmospheric pressure and humidity. Results: Adjusted linear regression analysis showed a direct relationship of OMT with the difference in systolic OBP minus systolic HBPM (beta = 0.153±0.025; p<0.001) and the difference in diastolic OBP minus diastolic HBPM (beta = 0.066±0.015; p<0.001). Adjusted logistic regression analysis showed that each 1oC OMT increase was associated with a higher risk of WCH (OR [95%CI] = 1.011 [1.001–1.021]; p = 0.025) and NT (OR [95%CI] = 1.059 [1.051–1.066; p<0.001], and lower risk of MH (OR [95%CI] = 0.965 [0.950–0.975]; p<0.001) and SH (OR [95%CI] = 0.945 [0.937–0.952]; p<0.001). Conclusions: Higher OMT is associated with greater difference in OBP levels relative to HBPM levels and is related to greater risk of WCH and NT and lower risk of MH and SH. These findings suggest that outdoor temperature should be considered in the evaluation and management of hypertension and BP phenotypes.

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