Target organ damage and masked hypertension in the general population

Abstract

The relation of masked hypertension to target organ damage has very seldom been investigated in a general population. An unselected population cohort (n = 1989 of which 1540 were not treated for hypertension) underwent office (duplicate measurements on one visit by a nurse) and home (duplicate measurements on 7 days) blood pressure (BP) measurements and evaluation of electrocardiographic left ventricular hypertrophy (ECG-LVH, n = 1989/1540), carotid intima-media thickness (cIMT, n = 758/592), and pulse wave velocity (PWV, n = 237/158). ECG-LVH was diagnosed using Cornell voltage criteria. PWV was measured using whole-body impedance cardiography. Masked hypertension was defined as office BP less than 140/90 mmHg with home BP at least 135/85 mmHg and white-coat hypertension as office BP at least 140/90 mmHg and home BP less than 135/85 mmHg. Masked and sustained hypertensive individuals had significantly higher age-adjusted and sex-adjusted Cornell voltage, cIMT, and PWV than normotensive individuals. White-coat hypertensive patients had higher age-adjusted and sex-adjusted Cornell voltage than normotensive individuals but significantly lower Cornell voltage and PWV than sustained hypertensive patients. The differences in Cornell voltage and PWV remained significant after adjustment for confounding factors. However, all differences became nonsignificant after adjustment for systolic home BP. Masked and sustained hypertension is accompanied by increased risk for hypertensive target organ damage, whereas white-coat hypertension seems to be a more benign phenomenon.