White-Coat and Masked Hypertension: Selective Elevation of Blood Pressure or an Arbitrarily Partitioned Continuum?

Abstract

HomeHypertensionVol. 48, No. 2White-Coat and Masked Hypertension: Selective Elevation of Blood Pressure or an Arbitrarily Partitioned Continuum? Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBWhite-Coat and Masked Hypertension: Selective Elevation of Blood Pressure or an Arbitrarily Partitioned Continuum? Iddo Z. Ben-Dov Iddo Z. Ben-DovIddo Z. Ben-Dov Nephrology and Hypertension Services, Hadassah–Hebrew University Medical Center, Jerusalem, Israel Search for more papers by this author Originally published12 Jun 2006https://doi.org/10.1161/01.HYP.0000228965.92166.42Hypertension. 2006;48:e8Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: June 12, 2006: Previous Version 1 To the Editor:Data from the Pressioni Arteriosc Monitorate e Loro Associazioni (PAMELA) study, presented by Mancia et al,1 are invaluable for understanding the true nature of white-coat and masked hypertension. Thus, in terms of long-term risk, the authors’ conclusions that these are not innocent entities and that physicians treating patients with any blood pressure should be aware of their consequences should be definitely adopted. However, the title of the article and some of the interpretations of the data ignore the authors’ acknowledged finding that subjects with white-coat and masked hypertension have in-office and out-of-office blood pressure values between normal and hypertensive levels. Thus, when defined by home blood pressure monitoring, subjects with white-coat hypertension have greater (rather than selective) elevation of office blood pressure. Likewise, subjects judged by ambulatory blood pressure monitoring to have masked hypertension do not have selective elevation of 24-hour blood pressure but rather a categorically more notable elevation compared with office values. A striking finding revealed in the article by the PAMELA authors is that, when categorized according to office and 24-hour blood pressure (Table 1, top),1 patients with white-coat and masked hypertension have similar home blood pressure values in between those of normotensive and hypertensive subjects. The same is true regarding 24-hour blood pressure values when home blood pressure is the basis of classification (Table 1, bottom).1 According to the age- and gender-adjusted mortality analyses, statistically significant findings were reported only for the combined subgroup, namely, the true hypertensive subjects. Therefore, the authors have not proven that being categorized as masked or white-coat hypertensive, and not the actual office or out-of-office blood pressure values, carries increased risk. The significant trend findings are conceivably strongly influenced by the mortality of the subgroups with combined elevations in blood pressure. Would adjustment for office blood pressure (in the case of masked hypertension), or out-of-office blood pressure (in the case of white-coat hypertension), not generate more pointed results?DisclosuresNone.1 Mancia G, Facchetti R, Bombelli M, Grassi G, Sega R. Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure. Hypertension. 2006; 47: 846–853.LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails August 2006Vol 48, Issue 2 Advertisement Article InformationMetrics https://doi.org/10.1161/01.HYP.0000228965.92166.42PMID: 16769993 Originally publishedJune 12, 2006 PDF download Advertisement SubjectsHypertension