Isolated Clinic Hypertension Research Articles

White-coat hypertension: management and adherence to guidelines by European and Canadian GPs. A cross-sectional clinical vignette study.

BackgroundWhite-coat hypertension (WCH) is also referred to as 'isolated clinic hypertension'. While it is a frequently encountered phenomenon, WCH is not systematically evoked, and its management remains unclear due to the contradictory guidelines provided by professional societies.AimTo examine WCH management by GPs in Europe and Canada.Design & settingA clinical vignette of a possible case of WCH was created from the literature, and the responses of GPs to WCH-specific questions in a cross-sectional electronic questionnaire were compared.MethodComplete electronic questionnaire responses from Europe and Canada were systematically analysed.ResultsAmong 770 eligible questionnaires (useful response rate: 10.6%), 43.5% were from France, 19.2% from Belgium, 7.8% from England, 19.5% from Switzerland, and 10.0% from Canada. Based on the clinical information provided in the vignette, GPs overall diagnosed hypertension and WCH equally (50.7% versus 49.3%, respectively). Canadian GPs suggested hypertension more frequently than European GPs in general (64.2% versus 46.1%, P<10–4), and more frequently used ambulatory blood pressure monitoring ([ABPM] 42.3% versus 26.1%, P = 0.01). In both groups of GPs, WCH was managed similarly (no treatment, 100% versus 97.3%, P = 0.39). Generally, the GPs all followed WCH patients for 3–6 months (51.3% versus 66.2%, P = 0.1), and they were not aware of the WCH guidelines (47.3% versus 52.1%, P = 0.54).ConclusionAlthough WCH guidelines are different, WCH management by GPs is very similar except for diagnosis. Homogeneity in WCH guidelines is required and should be systematically implemented in hypertension guidelines to avoid inappropriate management of the condition.

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Objective: The purpose of the study was to investigate the structural and functional state of heart and carotid arteries in males aged 18–25 years with different levels of blood pressure (BP). Design and method: A total of 120 males aged 18–25 years (mean age 21,4 ± 0,14 years) with documented high BP were included. Exclusion criteria were secondary forms of hypertension. The control group consisted of 20 healthy males. Clinical measurement of blood pressure, ambulatory blood pressure monitoring, Doppler echocardiography, ultrasonography of the brachiocephalic arteries were performed. Results: In the studied group of males aged 18–25 years there was a high prevalence of such risk factors as: smoking (56.6%), dyslipidemia (20.8%), abdominal obesity (18.3%). Clinically stable hypertension was defined in 81.7% pts. Hypertension in 59,2% of cases was expressed by isolated systolic hypertension, and systolic-diastolic hypertension in 40,8%. Pts with isolated clinical hypertension (ICH) and hypertension had significantly higher values of left ventricular (LV) mass index (by 16,9% and 26,8%, p < 0,01), and the relative wall thickness (by 16,7% and 26,9%, p < 0,01) compared to controls. Concentric LV remodeling was found in 25.8% of pts with ICH, and in 59.4% of pts with hypertension. Concentric LV hypertrophy was detected in 4,3% pts with hypertension. In pts with ICH and hypertension the E/A ratio was 9,6% and 18.2% (alll p < 0,05) lower than in the control group. There was a significant (p < 0,05) increase in the IMT by 13.3% and 20% in pts with ICH and hypertension, respectively. This corresponded to impaired arterial elastic properties, as evidenced by a reduced distensibility coefficient (DC) (by 33,3% and 41,7%, p < 0,05) and the elastic modulus (by 13,9% and 30,5%, p < 0,05) increase in the Young's modulus (by 16,7% and 26,2%, p < 0,05) and the Peterson's modulus (by 8,3% and 41,6%, p < 0,05) of the common carotid artery compared with the control group. Conclusions: Thus, in males aged 18–25 years with a history of hypertension the main risk factors are: smoking, abdominal obesity and dyslipidemia. Young hypertensive males have LV remodeling and impaired diastolic function, as well as increased carotid IMT and arterial wall stiffening.

Is white-coat hypertension a risk factor for carotid atherosclerosis? A review and meta-analysis.

The association of white-coat hypertension (WCH) with target organ damage is still debated; in particular, the relationship of this blood pressure phenotype with subclinical vascular damage remains controversial. Thus, we carried out a systematic review and meta-analysis to provide updated information on carotid structural changes in WCH. Studies were identified using the following search terms: 'white coat hypertension', 'isolated clinic hypertension', 'carotid artery', 'carotid atherosclerosis', 'carotid intima-media thickness', 'carotid damage', 'carotid thickening'. Full articles published in the English language in the last two decades reporting studies on adults were considered. A total of 3478 untreated patients, 940 normotensive (48% men), 666 WCH (48% men), and 1872 hypertensive individuals (57% men) included in 10 studies, were analyzed. Common carotid intima-media thickness (IMT) showed a progressive increase from normotensive (718±36 μm) to WCH (763±47 μm, standardized mean difference 0.54±0.13, P<0.01) and to hypertensive patients IMT (817±47 μm, standardized mean difference 0.45±0.14, P<0.01). After assessing data for publication bias, only the difference between normotensive and WCH patients remained significant. Our meta-analysis documents that common carotid IMT, a prognostically validated marker of vascular damage, is greater in WCH patients than in true normotensive individuals and is not different from sustained hypertensives. This finding supports the concept that WCH is not an entirely benign condition.

Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: a systematic review for the U.S. Preventive Services Task Force.

Elevated blood pressure (BP) is the largest contributing risk factor to all-cause and cardiovascular mortality. To update a systematic review on the benefits and harms of screening for high BP in adults and to summarize evidence on rescreening intervals and diagnostic and predictive accuracy of different BP methods for cardiovascular events. Selected databases searched through 24 February 2014. Fair- and good-quality trials and diagnostic accuracy and cohort studies conducted in adults and published in English. One investigator abstracted data, and a second checked for accuracy. Study quality was dual-reviewed. Ambulatory BP monitoring (ABPM) predicted long-term cardiovascular outcomes independently of office BP (hazard ratio range, 1.28 to 1.40, in 11 studies). Across 27 studies, 35% to 95% of persons with an elevated BP at screening remained hypertensive after nonoffice confirmatory testing. Cardiovascular outcomes in persons who were normotensive after confirmatory testing (isolated clinic hypertension) were similar to outcomes in those who were normotensive at screening. In 40 studies, hypertension incidence after rescreening varied considerably at each yearly interval up to 6 years. Intrastudy comparisons showed at least 2-fold higher incidence in older adults, those with high-normal BP, overweight and obese persons, and African Americans. Few diagnostic accuracy studies of office BP methods and protocols in untreated adults. Evidence supports ABPM as the reference standard for confirming elevated office BP screening results to avoid misdiagnosis and overtreatment of persons with isolated clinic hypertension. Persons with BP in the high-normal range, older persons, those with an above-normal body mass index, and African Americans are at higher risk for hypertension on rescreening within 6 years than are persons without these risk factors. Agency for Healthcare Research and Quality.

White-coat hypertension, as defined by ambulatory blood pressure monitoring, and subclinical cardiac organ damage: a meta-analysis.

: The clinical and prognostic relevance of white-coat hypertension (WCH) has not been fully elucidated; in particular, the association of this blood pressure phenotype with suclinical organ damage remains unclear. We performed a systematic meta-analysis in order to provide a comprehensive information on cardiac structural and functional changes in WCH, as defined by ambulatory blood pressure monitoring. Studies were identified by the following search terms: 'white-coat hypertension', 'isolated clinic hypertension', 'cardiac organ damage', 'target organ damage', 'left ventricle', 'left ventricular hypertrophy', 'cardiac hypertrophy', 'ventricular dysfunction', and 'echocardiography'. A total of 7382 untreated adult patients (2493 normotensive, 1705 WCH, and 3184 hypertensive individuals) included in 25 studies were considered. Left ventricular mass index was higher in WCH than in normotensive patients [standardized difference in mean (SDM) 0.50, P < 0.01]; mitral E/A ratio was lower (SDM -0.27, P < 0.01) and left atrium larger (SDM 0.29, P < 0.05) in WCH than in the normotensive counterparts. Hypertensive patients showed a greater left ventricular mass index (SDM 0.42, P < 0.01), reduced E/A (SDM -0.15, P < 0.01), and larger left atrium diameter (SDM 0.27, P < 0.01) than WCH patients. Our meta-analysis shows that alterations in cardiac structure and function in WCH patients, as defined by ambulatory blood pressure monitoring, are intermediate between sustained hypertensive patients and normotensive controls. The study supports the view that WCH should not be further considered a fully benign entity.

Control de la presión arterial en unidades hospitalarias de referencia en España

Background and objectiveBlood pressure (BP) control has been extensively studied in patients attended in primary care but reports in the hospital setting, which includes referral units, are scarce. The aim was to evaluate the degree of BP control in hypertensive patients attended in referral units. Patients and methodsWe studied 1,550 hypertensive subjects (41.5% women) with a mean age of 64 (12) years, who were receiving antihypertensive drugs. The degree of BP control was estimated in a single visit by the proportion of patients with BP below 140/90mmHg. ResultsBP was controlled in 653 patients (42%). In comparison, those whose BP was not controlled were more frequently women (odds ratio [OR] 1.57; 95% confidence interval [95%CI]: 1.23-1.99), obese (OR 1.28; 95%CI 1.00-1.63), smokers (OR 1.78; 95%CI 1.36-2.34), had left ventricular hypertrophy (OR 1.86; 95%CI 1.46-2.36) and elevated values of total serum cholesterol (OR 1.50; 95%CI 1.19-1.90) and triglycerides (OR 1.63; 95%CI 1.29-2.07). Therapeutical inertia was observed in 39% of uncontrolled patients. In a subgroup of patients who underwent ambulatory BP monitoring, discordance between measurements was only present in 23% (9.8 with isolated clinic hypertension and 13.1% with masked hypertension). ConclusionThe degree of BP control in patients attended in referral units is estimated in 42% and has not been modified in the last decade. Although therapeutical effort and inertia have improved, this only compensates the increased risk and comorbidities of attended patients, making more difficult the control of BP values.

Two hour glucose post loading: a biomarker of cardiovascular risk in isolated clinic hypertension

Isolated clinic hypertension (ICHT) may be an indicator of both future hypertension and diabetes. This study examines the 2-h plasma glucose level post load (2hPG), and measures of arterial stiffness, autonomic function and circulating biomarkers in ICHT, normotension and hypertension. Participants aged 39-75 years, who were untreated for hypertension, nonsmokers and not known diabetic (n=105) were categorized as normotension, ICHT and hypertension, based on clinic and mean daytime ambulatory blood pressures. Participants had measurements of autonomic function, aorto-femoral pulse wave velocity (PWVc), as well as blood sampling for lipids and potential circulating biomarkers [high sensitivity C-reactive protein (hsCRP), plasminogen activator inhibitor 1 (PAI-1), asymmetric dimethylarginine (ADMA), and von Willebrand factor (vWF)], followed by a glucose tolerance test. A total of 8.3% normotension, 37.9% ICHT and 15% hypertension patients had impaired glucose tolerance. Mean 2hPG adjusted for age and waist circumference was 5.7 mmol/l [interquartile range (IQR) 5.2-6.4] for normotension, 7.4 mmol/l (IQR 6.5-8.3) for ICHT (P=0.002 vs. normotension) and 6.2 mmol/l (IQR 5.6-6.9) for hypertension group. Other measures of insulin resistance were similar in the three groups. Mental stress testing induced a greater blood pressure response in the ICHT group (P=0.01 vs. normotension); other autonomic function measures were similar in the three groups. Mean PWVc, adjusted for age and blood pressure, was similar in ICHT and normotension but increased in the hypertension group. Circulating biomarker levels were not different in the three groups. Assessment of total cardiovascular risk in patients with ICHT should include measurement of postprandial glucose.

Isolated clinical hypertension diagnosis

Self-blood pressure (BP) measurement (SBPM) and ambulatory BP measurement (ABPM) are suitable for the isolated clinical hypertension (ICH) or 'white-coat' hypertension diagnosis. However, patients with ICH have a different cardiovascular risk according to the measurement technique used for the diagnosis. To describe baseline cardiovascular risk of patients with hypertension and with ICH according to SBPM and daytime ABPM. Six hundred and sixty-four newly diagnosed and never treated patients with hypertension and with an average age of 59.3 years (standard deviation=12.0) were included (52% men) in this study. Clinical data, analytical data with urinary albumin excretion rate, estimated glomerular filtration rate, retinography, SBPM, and ABPM were performed. Cardiovascular risk was estimated from the European Society of Hypertension and Systemic Coronary Risk Evaluation tables. ICH prevalence varies according to the ambulatory measurement technique used: SBPM=24.2%, daytime ABPM=8.1, and 5.2% if criteria are required from both techniques. In the 403 patients with hypertension and who had SBPM and ABPM, the percentage of patients with high or very high baseline cardiovascular risk, falls progressively from 31.2% of patients with sustained hypertension to 20.0% of patients with ICH measured using SBPM, to 15.1% of patients with ICH measured using ABPM-day and to 9.5% of patients who present ICH using both techniques (P<0.005 for trend). The baseline results show that patients with hypertension and with ICH using SBPM and daytime ABPM are those who have a lower baseline cardiovascular risk and allow ICH to be defined on the basis of normal ambulatory readings using both techniques.

Isolated clinic hypertension: diagnostic criteria based on 24-h blood pressure definition

The use of diagnostic criteria based on 24-h ambulatory blood pressure (BP) values could improve prognostic value by incorporating night BP, minimize biases and improve the diagnostic reproducibility of isolated clinic hypertension (ICH). We estimate the 24-h BP cut-off points that best discriminate and predict the two diagnostic thresholds of mean daytime BP for ICH (135/85 and 130/80 mmHg). Cross-sectional, comparative, multicentre study in 6176 untreated hypertensive patients, whose BP was measured by ambulatory BP monitoring. ICH was defined with an office BP of ≥140/≥90 mmHg and a daytime BP of <135/<85 mmHg (ICH1) or <130/80 mmHg (ICH2). Sensitivity, specificity, positive likelihood ratio (LR+), odds ratio (OR), error rate, predictive values, κ values and 95% confidence interval were calculated for each possible cut-off point for ICH1 and ICH2. One thousand eight hundred and seven patients (29.2%) and 960 patients (15.5%) met ICH1 and ICH2 criteria, respectively. The 24-h BP cut-off points that best predict ICH1 and ICH2 are less than 132/82 mmHg (sensitivity: 93.6%, specificity: 94.3%, LR+: 16.6, OR: 1367.1, error rate: 5.9, κ 0.86) and less than 127/77 mmHg (sensitivity: 90.8%, specificity: 97.4%, LR+: 34.6, OR: 1041.5, error rate: 3.6,κ 0.86), respectively. These values achieved the best balance of sensitivity and specificity, together with the highest values of LR+ and OR and the lowest error rate. The 24-h BP cut-off point that best predicts the daytime criterion of less than 135/85 and less than 130/80 mmHg are 132/82 and 127/77 mmHg, respectively. These 24-h cut-off points may add value to ambulatory blood pressure monitoring for both diagnostic and management future decisions.

Measurement of Blood Pressure in the Office

To the Editor: The algorithm for office blood pressure recently proposed by Myers et al1 does not allow for the discernment of isolated clinic or masked hypertension. In a recent study we measured observed automated blood pressure (nurse present), unobserved automated blood pressure (3 readings at 3-minute intervals after 5 minutes of rest), and ambulatory blood pressure in groups of subjects with normal blood pressure, isolated clinic hypertension, and untreated essential hypertension. Mean daytime awake and automated unobserved blood …

Pronóstico y recomendaciones para el manejo de la hipertensión clínica aislada

Patients with isolated clinic hypertension (ICH) have a lower medium-term mortality rate than patients with sustained hypertension. However, these patients have greater target organ damage and therefore, in general, are at higher cardiovascular risk than normotensive individuals. Up to 18% of patients with ICH may present a high or very high added cardiovascular risk because of concomitant risk factors (smoking, dyslipidemia, diabetes, metabolic syndrome), or the presence of target organ damage or established cardiovascular disease. ICH is difficult to predict clinically and 24-hour ambulatory blood pressure monitoring is required for an accurate diagnosis. There will probably never be a highly sensitive screening test or algorithm that will identify patients requiring ambulatory blood pressure assessment. Therefore, given the prevalence of ICH (between 15 and 30% of hypertensive patients), ambulatory blood pressure monitoring is advisable in most hypertensive patients, at least initially. Defining ICH with the more restrictive cut-off point (24 h blood pressure < 127/77 mmHg or daytime blood pressure <130/80 mmHg) seems reasonable, particularly in patients at highest cardiovascular risk.

Should White-Coat Hypertension in Diabetes Be Treated? Pro

White coat hypertension, which should be more descriptively termed “isolated clinic hypertension” (1), consists of a condition in which clinic (or office) blood pressure is repeatedly ≥140 mmHg systolic or 90 mmHg diastolic, whereas 24-h mean blood pressure is below its generally accepted upper limit of normality, i.e., <125/80 mmHg (1,2). This article will first show evidence from the PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) population study that isolated clinic hypertension is associated with a prevalence of organ damage and a risk of cardiovascular morbidity and mortality, which, although less than those of patients with in- and out-of-office hypertension, are distinctly greater than those displayed by truly normotensive subjects. It will then emphasize that in diabetic subjects, limited evidence is available on the prevalence of isolated clinic hypertension as well as on its association with diabetic-related microvascular and macrovascular disease. In this context, some specific difficulties exist, i.e., 1 ) the uncertainty about whether the cut-off clinic and ambulatory blood pressure values to use should (or should not) be different from those used in nondiabetic individuals, 2 ) the small number of subjects and events in the few studies that have addressed this issue, and 3 ) the confounding effect of factors such as the duration of diabetes, the extent and type of blood pressure–lowering treatments, and the more or less effective blood glucose control when subjects with and without isolated clinic hypertension are compared. It will be concluded, however, that recommendations on this matter should take into due account that, in diabetes, cardiovascular and renal protection are enhanced by aggressive reductions in clinic blood pressure (<130/80 mmHg) and that lowering blood pressure is beneficial even when the initial clinic value is within the normal blood pressure range, i.e., 130–139 mmHg (2). This scores in favor of a systematic blood …

Cardiorenal continuum in hypertensive pregnancy

Risk factors (RF), initial stages, progression, and final stage of both cardiovascular disease (CVD) and chronic kidney disease (CKD) were analyzed in a cohort of 159 pregnant women with hypertensive disorders versus a cohort of 32 healthy pregnant controls. Cardiorenal continuum factors were separately investigated in patients with different gestational hypertension (HT) depending on the diagnostic method: 13 with isolated clinic HT (1CHT), 11 - isolated ambulatory HT (IAHT), and 18 - HT found by all three blood pressure (BP) measurement methods (clinic, ambulatory, and home BP). The number of RF (age, family history of CVD and pre-eclampsia, pre-pregnancy history of smoking, lack of physical exercise, and oral contraception, BP levels, abdominal obesity, dyslipidaemia, anxiety and depression, oxidative stress, altered fasting plasma glucose, metabolic syndrome), signs of subclinical organ damage (cell membrane destabilization, left ventricular hypertrophy, intima-media thickening, slight increase in serum creatinine, hyperuricaemia, endothelial dysfunction, albuminuria, low glomerular filtration rate), and total cardiovascular risk progressively increased from the condition of being normotensive at the time of office, home, and 24-hour measurements to the condition of being found hypertensive by one, two and all three BP measurement methods, forming the continuum «healthy pregnant women - ICHT - IAHT - gestational HT». Assessment of cardiorenal state in all pregnant women allowed to compose the cline «healthy pregnants- gestational HT- stage I essential HT - stage II essential HT - pre-eclampsia - essential HT with superimposed pre-eclampsia» with the growing risk of CVD and CKD and potential danger of cardiovascular events and chronic renal failure.

Insulin resistance, arterial stiffness and circulating biomarkers in isolated clinic hypertension

Insulin resistance, arterial stiffness and circulating biomarkers in isolated clinic hypertension

Clinical characteristics of isolated clinic hypertension

To analyze the clinical characteristics of patients with isolated clinic hypertension (ICH) compared with other hypertensive patients, and to evaluate the capacity of physicians to predict a diagnosis of ICH. A cross-sectional, comparative multicenter descriptive study was made of 6176 hypertensive individuals without pharmacological treatment, subjected to ambulatory blood pressure monitoring (ABPM). In 2611 cases, ABPM was prescribed due to suspected ICH. The participants were consecutively selected in primary care centers and hospital hypertension units in all Spanish Autonomous Communities. ICH was defined by clinical blood pressure (BP) >or= 140 mmHg (systolic) or >or= 90 mmHg (diastolic), with diurnal ambulatory BP < 135 and < 85 mmHg (ICH1) or BP < 130 and < 80 mmHg (ICH2) or 24-h BP < 125 and < 80 mmHg (ICH3). ICH1, ICH2 and ICH3 criteria were met by 1807 (29.2%), 960 (15.5%) or 1133 (18.3%) subjects, respectively. Total sample mean age (SD) was 51.8 (14.1) years, and clinical BP 145.7 +/- 17.3/89.3 +/- 11.3 mmHg. Compared with the rest of the hypertensive individuals, the patients with ICH were predominantly female, of older age, with fewer smokers, and increased frequency of obesity. Moreover, they were more frequently nondippers, and with greater systolic BP in the office (P < 0.05), except when we used ICH3 criteria. The sensitivity and specificity of the physician predictions in relation to suspected ICH1, ICH2 and ICH3 were 48.7 and 60.4%, 52.9 and 59.7%, and 52.3 and 60.0%, respectively. The prevalence of ICH is between 15 and 29%, depending on the defining criterion used. The 24-h ICH criteria are not affected by awake/sleep biases, and should be preferred. Clinical capacity for predicting ICH is low.

Valores de normalidad de la automedida de la presión arterial en relación con la presencia de lesión en los órganos diana. Datos del estudio VAMPAHICA

International guides of hypertension (HT) recommend self-blood -pressure-measurement (SBPM) values higher than 135/85 mmHg to determine isolated clinical hypertension (ICH). This paper suggests a lower cut-off. This prospective, protocol-based study included 378 patients, 250 new hypertensive patients without previous treatment. Both SBPM and ambulatory blood pressure monitoring (ABPM) were measured in all patients. Risk factors and target organ disease (TOD) were evaluated by electrocardiography, renal function, microalbuminuria and retinography. With a 135/85 mmHg ICH cut-off, only differences in serum creatinine levels (78.67 ICH vs 83.98 micromol/l sustained HT -SHT-; p = 0.03), grade I/II fundus oculi (FO) lesions (44.7 vs 62.8%; p = 0.009) and any FO lesions (48.2 vs 67.4%; p = 0.005) were found. With a ICH cut-off of 130/80 mmHg, a lower risk of grade III/IV FO lesions was found (RR = 0.59; 90% confidence interval [CI], 0.36-0.96; p = 0.06). Any TOD risk was related to SHT with a 130/85 mmHg cut-off (RR = 12.04; 90% CI, 1.03-140.28; p = 0.09). Taking a 135/85 mmHg ICH cut-off, no differences in TOD between ICH and SHT were found. Taking a 130 mmHg ICH systolic blood pressure (SBP) cut-off, those who are below 130 mmHg have a lower risk of grade III/IV FO lesions. Those who are above this value have a higher TOD risk. Looking at TOD risk, we should consider a < 130 mmHg SBP cut-off for ICH diagnosis.

MECHANICAL AND CIRCULATING BIOMARKERS IN ISOLATED CLINIC HYPERTENSION

1. This review examines the current evidence for altered mechanical and circulating biomarkers in isolated clinic hypertension and their potential significance. 2. Arterial stiffness, as assessed by central pulse wave velocity, is influenced by multiple cardiovascular risk factors; however, an independent association with isolated clinic hypertension (ICHT) has not been convincingly shown in four small studies. 3. Endothelial dysfunction, as assessed by brachial artery flow-mediated vasodilation, circulating levels of endothelial markers (e.g. nitrite/nitrate, von Willebrand factor, endothelin-1) and/or circulating levels of inhibitors of vascular nitric oxide (plasma asymmetric dimethylarginine, homocysteine), has been shown to be present in established hypertension and to a variable and inconsistent extent in subjects with ICHT. 4. Evidence of increased oxidative stress in ICHT versus normotensive subjects was found in two of three studies. 5. Circulating inflammatory markers C-reactive protein and plasminogen activator inhibitor-1 were significantly increased in two of three and two of two studies, respectively, in ICHT compared with normotensive subjects. 6. Urinary albumin excretion is a marker of both arterial and renal disease. The consensus from seven studies in patients with ICHT is that albuminuria is not an independent marker for ICHT. 7. Studies to date assessing biomarkers in ICHT have been small and cross-sectional. Larger, long-term longitudinal studies of arterial functional and circulating biomarkers are required to assess the potential vascular impact of ICHT.

Reliability of Blood Pressure Patterns Defined by a Single 24-Hour Ambulatory Blood Pressure Monitoring: The Case of the Dipping/Non Dipping and Isolated Clinic Hypertension

Classification of hypertensive subjects according to different blood pressure patterns : i.e sustained vs isolated clinic hypertension (ICH) , dipping vs non dipping is now regarded as a useful mean for a more precise individual risk stratification and therapeutic making decisions. However, this subdivision is routinely based on a single ambulatory blood pressure monitoring (ABPM), despite the well-known day-to-day variability in blood pressure due to variations in mental, physical and environmental stimuli. In this short review we have tried to answer the following question : how reliable is the classification of non-dipping and ICH pattern based on single 24-h ABPM recording? Data from the recent literature clearly indicate that these categorizations in non diabetic mild to moderate hypertensive patients on the basis of a single ABPM are highly unreliable , as a large fraction of subjects (20-50%) classified in these categories at the first ABPM, do not confirm the same BP pattern during a second ABPM. Thus, these findings support the idea that a more reliable classification of patients according to dipping/nondipping status or ICH vs sustained hypertension should be performed by repeating a second ABPM within a short-term period.

Differences in personality between sustained hypertension, isolated clinic hypertension and normotension

The aim of this study was to determine whether there are differences in personality between hypertension and normotension. Forty‐two male patients with essential hypertension were divided into two groups after self‐assessment of blood pressure, 18 with sustained hypertension and 24 with isolated clinic (white coat) hypertension, and were compared with 25 men with normotension on Spielberger's State‐Trait Anxiety Inventory and the Jenkins Activity Survey. In line with hypotheses, the sustained hypertensive group showed higher levels of trait anxiety, Type A behaviour pattern, and hard‐driving behaviours/competitiveness than the normotensive group, whereas isolated clinic hypertensives occupied an intermediate position between those two groups. Results provide support to the hypothesised relationship between personality and hypertension and stress the need of distinguishing sustained hypertension from isolated clinic hypertension. Copyright © 2006 John Wiley &amp; Sons, Ltd.

How reliable is isolated clinical hypertension defined by a single 24-h ambulatory blood pressure monitoring?

Isolated clinical hypertension (ICH) is characterized by a persistently elevated clinic blood pressure in the presence of a normal day-time or 24-h ambulatory blood pressure (ABP). This definition is based on a single ABP monitoring (ABPM) and little attention has been focused on the reproducibility of this condition. To investigate the reliability of the criteria currently recommended by major hypertension guidelines to detect ICH based on a single 24-h ABPM session. A total of 611 never-treated grade 1 and 2 hypertensive patients (mean age 46 +/- 12 years) referred for the first time to our out-patient clinic, underwent repeated clinic blood pressure measurements, routine investigations, two 24-h periods of ABPM 1-4 weeks apart, cardiac and carotid ultrasound examinations. ABPM was always performed over a working day and the same daily activities were recommended during the two periods. ICH was diagnosed by the following criteria: (i) mean daytime values < 135/85 mmHg or (ii) mean 24-h blood pressure values < 125/80 mmHg during the first ABPM. The overall prevalence of ICH was 7.1% according to criterion (i) and 5.4% according to criterion (ii). Twenty (46.6%) of the 43 patients with mean daytime blood pressure values < 135/85 mmHg during the first ABPM, exceeded this cut-off value during the second ABPM period. Twenty-two (66.6%) of the 33 patients with mean 24-h blood pressure values < 120/80 mmHg during the first ABPM did not confirm a normal blood pressure profile during the second ABPM recording. Cardiovascular involvement was significantly lower in subjects with persistent normal ABP compared to those with non-reproducible ICH pattern or sustained hypertensives. These findings clearly indicate that: (i) the classification of ICH on the basis of a single ABPM, using the cut-offs suggested by major hypertension guidelines, has a limited short-term reproducibility and (ii) repeated ABPM recordings should be recommended to correctly diagnose patients with ICH and improve cardiovascular risk stratification.