Prevalence Of Masked Hypertension Research Articles

A16036 Large Discrepancy between Unobserved Automated Office Blood Pressure and Ambulatory Blood Pressure in a High Cardiovascular Risk Cohort

Objectives: Recently, automated office blood pressure (AOBP) has been shown to eliminate the white-coat effect and to be more concordant with ambulatory blood pressure monitor (ABPM) and home blood pressure (BP) measurements. The purpose of this study was to compare BP measured by AOBP with that by ABPM in high cardiovascular risk patients. Methods: The study participants were recruited from a prospective cohort study (Cardiovascular and Metabolic Disease Etiology Research Center–High Risk Cohort [CMERC-HI]; clinicaltrials.gov: NCT02003781). 1,208 participants who had undergone both AOBP and ABPM within 7days of each measurement were analyzed for this study. Results: The 95% limits of agreement between systolic AOBP and daytime ABPM systolic blood pressure (SBP) were − 34.78 to 20.19 mmHg (mean difference = − 7.30 ± 14.0). The mean differences in quintiles of AOBP distributions increased with decreasing AOBP measurements [ − 17.8 ± 11.2 (Q1, systolic AOBP < 113), − 10.9 ± 11.1 (Q2, systolic AOBP 113–121), − 8.5 ± 10.7 (Q3, systolic AOBP 121–128), − 4.2 ± 11.8 (Q4, systolic AOBP 128–137), 4.9 ± 14.2 (Q5, systolic AOBP > 137), p < 0.001]. The prevalence of masked uncontrolled hypertension was 310 (25.7%), and the prevalence of white-coat effects was 102 (8.4%). Large discrepancy was significantly associated with lower systolic AOBP, higher ASCVD risk score, and history of cardiovascular disease. Conclusion: Lower range of systolic AOBP showed a large discrepancy with daytime ABPM SBP and a high prevalence of masked hypertension in high-risk patients. The status of BP control should be confirmed by out-of-office BP measurements, even when using AOBP as a clinical BP of reference in high-risk patients.

Ambulatory blood pressure monitoring in young adults with different levels of office blood pressure

Objectiveof our study was to assess the ambulatory blood pressure monitoring (ABPM) in young people with different office blood pressure (BP).Design and methods. We included 981 students of a medical university at the age of 20–29 years (536 men, 445 women). ABPM was performed using the device “Kardiotekhnika 4000” (Inkart, Russia), the data were processed using the program “KT Result2” (Inkart, Russia).Results. The optimal BP during office measurement was recorded in 220 patients (22,4 %, group 1), normal — in 488 (49,8 %, group 2), high normal — in 134 (13,6 %, group 3), hypertension (HTN) 139 (14,2 %, group 4). The proportion of males was significantly higher in groups 3 and 4 (96,6 % and 85,6 %) compared with groups 1 and 2 (47,7 % and 40,2 %, respectively, p &lt; 0,001). The median systolic BP (SBP) was 123 (110; 126) mm Hg, diastolic BP (DBP) — 85 (84; 87) mm Hg. According to the ABPM, the parameters of SBP and DBP correlated with the corresponding office BP parameters. A strong direct correlation was found for both SBP (rs= 0,87) and DBP (rs= 0,85). Daytime variability of SBP was significantly higher in individuals with high normal BP and HTN (15,9 ± 2,6 and 17,2 ± 4,2 mm Hg) compared to groups 1 and 2 (9,2 ± 4,4 and 9,9 ± 3,0, respectively, p &lt; 0,05). The majority of young people had normal BP decrease at night (dipper), non-dipper profile was also frequent. Over-dipper and night-peaker profiles were rarely recorded. In the groups 3 and 4, a larger number of non-dipper patients were observed compared with groups 1 and 2 (23,9 % and 34,6 %, compared with 10,0 % and 11,1 %, respectively, p &lt; 0,001). The prevalence of white-coat hypertension (WCH) among the young people was 0,31 % (95 % CI 0,06–0,75 %), among subjects with office HTN 2,2 % (95 % CI 0,4–5,3 %). The prevalence of masked hypertension (MHTN) in the studied population was 1,4 % (95 % CI 0,8–2,3 %), among normotensive subjects — 1,7 % (95 % CI 0,9–2,6 %), among subjects with high normal BP — 10,4 % (95 % CI 5,8–16,2 %).Conclusions. ABPM in young hypertensive patients is characterized by higher variability of daytime SBP. The majority (56,1 %)of HTN subjects had normal BP decrease at night. The prevalence of WCH among young people is 0,31 % (95 % CI 0,06–0,75 %). The prevalence of MHTN among young people is 1,4 % (95 % CI 0,8–2,3 %).

Abstract P234: Obstructive Sleep Apnea is More Common in Patients With Masked Uncontrolled Hypertension

Introduction: Masked uncontrolled hypertension (MUCH) is defined as controlled automated office blood pressure (AOBP) in clinic, but uncontrolled out-of-clinic BP by 24-hr ambulatory blood pressure monitoring (ABPM). Prior studies indicate that the prevalence of masked hypertension in patients with newly diagnosed obstructive sleep apnea (OSA) is nearly 30%. In addition, patients with OSA have a higher prevalence of masked hypertension than patients without OSA. Aim: Prospective determination of the prevalence and severity of OSA in patients with MUCH. Methods: In this prospective evaluation, 167 treated hypertensive patients were recruited from the University of Alabama at Birmingham Hypertension Clinic after having controlled BP at three or more clinic visits. All patients were evaluated by AOBP with the BpTRU device, ABPM, and diagnostic polysomnography (PSG) to determine the presence and severity of OSA based on the apnea-hypopnea index (AHI). Out of 153 who completed ABPM, 58 patients were controlled by AOBP and by ABPM, indicating true controlled hypertension and the remaining 95 patients were controlled by AOBP, but uncontrolled by ABPM, indicative of MUCH. 49 true controlled hypertensive and 69 MUCH patients completed PSG. Results: MUCH patients had a mean AHI of 10.3±13.3 compared to 4.5±10.2 events/hr in true controlled hypertension (p =0.045). Overall, the prevalence of OSA was 48.5% in patients with MUCH compared to 26.5% in true controlled hypertension (p = 0.01). Conclusion: MUCH has significant higher prevalence and severity of OSA compared to true controlled hypertension. These findings suggest that untreated OSA may contribute to the development of MUCH.

Prevalence of white coat and masked hypertension in Africa: A systematic review and meta-analysis.

Data on masked hypertension (MH) and white-coat hypertension (WCH) in African populations are needed to estimate the true prevalence of hypertension in these populations because they have the highest burden of the disease. We conducted the first systematic review and meta-analysis that summarized available data on the prevalence of WCH and MH in Africa. We searched PubMed and Scopus to identify all the articles published on MH and WCH in populations living in Africa from inception to November 30, 2017. We reviewed each study for methodological quality. A random-effects model was used to estimate the prevalence of WCH and MH across studies. Eleven studies were included, all having a low-risk of bias. The prevalence of masked hypertension was 11% (95% CI: 4.7-19.3; 10 studies) in a pooled sample of 7789 individuals. The prevalence of WCH was 14.8% (95% CI: 9.4-21.1; 8 studies) in a pooled sample of 4451 individuals. There was no difference on the prevalence of WCH and MH between studies in which participants were recruited from the community and the hospital. The prevalence of MH was higher in urban areas compared to rural ones; there was no difference for WCH. WHC and MH seem to be frequent in African populations, suggesting the importance of out-of-clinic BP measurement in the diagnosis and management of patients with hypertension in Africa, especially in urban areas for MH.

Is tinnitus an early voice of masked hypertension? High masked hypertension rate in patients with tinnitus

ABSTRACTObjectives: Tinnitus is hearing a sound without any external acoustic stimulus. There are some clues of hypertension can cause tinnitus in different ways. The aim of the study was to evaluate the relationship between tinnitus and masked hypertension including echocardiographic parameters and severity of tinnitus.Methods: This study included 88 patients with tinnitus of at least 3 months duration and 85 age and gender-matched control subjects. Tinnitus severity index was used to classify the patients with tinnitus. After a complete medical history, all subjects underwent routine laboratory examination, office blood pressure measurement, hearing tests and ambulatory blood pressure monitoring. Masked hypertension is defined as normal office blood pressure measurement and high ambulatory blood pressure level.Results: Baseline characteristics in patients and controls were similar. Prevalence of masked hypertension was significantly higher in patients with tinnitus than controls (18.2% vs 3.5%, p = 0.002). Office diastolic BP (76 ± 8.1 vs. 72.74 ± 8.68, p = 0.01), ambulatory 24-H diastolic BP (70.2 ± 9.6 vs. 66.9 ± 6.1, p = 0.07) and ambulatory daytime diastolic BP (73.7 ± 9.5 vs. 71.1 ± 6.2, p = 0.03) was significantly higher in patients with tinnitus than control group. Tinnitus severity index in patients without masked hypertension was 0 and tinnitus severity index in patients with masked hypertension were 2 (1–5).Conclusion: This study demonstrated that masked hypertension must be kept in mind if there is a complaint of tinnitus without any other obvious reason.

Increased masked hypertension prevalence in patients with obesity

ABSTRACTObjectives: Masked hypertension is associated with an increased risk for cardiovascular conditions. The aim of the study was to evaluate the relationship obesity parameters, including body weight, waist circumference, and body mass index.Methods: The study group consisted of 251 consecutive outpatient subjects without overt hypertension. Subjects were classified according to BMI. After a complete medical history and laboratory examination, patients’ height, weight, waist circumference heart rate, and office blood pressure were recorded. All subjects underwent ambulatory blood pressure monitoring. Masked hypertension is defined as normal office blood pressure measurement and high ambulatory blood pressure level.Results: Baseline characteristics in patients and controls were similar. Prevalence of Masked hypertension was significantly higher in patients with obesity than controls (30.9% vs 5.7%, p < 0.001). Body mass index (33.2 ± 4.3 vs 25.1 ± 2.7 p < 0.001), waist circumference (98.5 ± 11.7 vs 86.8 ± 8.8, p < 0.001), and weight (86.5 ± 11.8 vs. 69 ± 9.1, p < 0.001) in patients with obesity were significantly higher than in patients with normal weight. Office Systolic BP (121.8 ± 4.4 vs 120.5 ± 4.78, p = 0.035), ambulatory daytime systolic BP (128.8 ± 8.9 vs 124.5 ± 7.4, p < 0.001), ambulatory daytime diastolic BP (73.9 ± 9.5 vs 71.5 ± 7.0, p = 0.019), ambulatory night-time systolic BP in patients with obesity was significantly higher than in patients with normal weight.Conclusion: This study demonstrated that masked hypertension prevalence is higher in patients with obesity than control patients. It can be suggested that predefining obesity might be helpful in early detection of masked hypertension.

Ambulatory Hypertension in a Pediatric Cohort of Sickle Cell Disease

▪Background and Objectives: Hypertension is an established risk factor for subsequent cardiovascular and renal disease in children as well as adults. Sickle Cell Disease (SCD) is a genetic disorder associated with anemia with the major manifestation of vaso-occlusive crises. While this disease entity involves most organ systems causing vascular and pulmonary injury, little is known about blood pressure (BP) levels or prevalence of hypertension in children and adolescents with SCD.Methods: We enrolled 41 children with severe genotypes of SCD (39 with Hb SS disease and 2 with Hb Sβ0 thalassemia). Study participants underwent 24-hour ambulatory blood pressure monitoring (ABPM). Clinical information regarding duration of SCD, SCD-related complications, requirement for chronic blood transfusion and chronic hydroxyurea therapy were obtained. Baseline characteristics obtained on each participant included age, gender, weight, height, body mass index (BMI) percentile, BMI-Z score and clinic BP. Serum creatinine and cystatin C were obtained to assess estimated glomerular filtration rate (eGFR) with age-based formulas. A random urine sample was obtained for standard urinalysis, albumin and creatinine estimation, to calculate urine albumin to creatinine ratio.Results: Based on ABPM study results participants were categorized into three groups as normal ABPM, abnormal ABPM, or hypertension ABPM (ambulatory hypertension, masked hypertension or severe ambulatory hypertension). The term abnormal ABPM designated participants who did not have normal ABPM or hypertension, but had other abnormal parameters on ABPM (presence of pre-hypertension and/or lack of normal nocturnal dipping). SCD children in the three groups were similar with respect to distribution of age, BMI z-scores, renal function, urine albumin excretion, urine osmolality, hemoglobin, history of chronic blood transfusion, and hydroxyurea therapy. Twelve participants (29.3%) met criteria for hypertension based on ABPM. Of the 12 hypertensive participants, three had clinic hypertension with ambulatory hypertension; and nine had masked hypertension detected on ABPM. Youngest child with ABPM confirmed hypertension was six years of age. Another 18 participants (43.9%) had some abnormal ABPM parameters that were largely present in the sleep period of ABPM.Conclusions: Findings from our study indicate that BP abnormalities are not uncommon in SCD children. Overall, the distribution of confirmed hypertension, largely manifested by masked hypertension, is high in pediatric participants with SCD; as young as 6 years of age. The underlying cause for the relatively high prevalence of masked hypertension and abnormal ABPM parameters including absence of nocturnal BP dip in children with SCD is unclear. Based on our findings more attention should be given to monitoring and management of BP in children with SCD. Early identification of hypertension in SCD children can confer benefit because hypertension is an important modifiable risk factor for progression of cardiovascular and renal disease.Acknowledgment: Research reported in this publication was supported by the National Institute Of General Medical Sciences of the National Institutes of Health under Award Number P20GM109021; National Kidney Foundation Young Investigator Grant and DE-CTR-ACCEL grant number U54-GM104941 (PI: Binder-Macleod). [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

OP.1A.09] ORTHOSTATIC HYPERTENSION PREDICTS MASKED HYPERTENSION IN THE VERY ELDERLY TREATED HYPERTENSIVES

Objective: Masked hypertension (MHT) and isolated nocturnal hypertension are associated with increased risk of target organ damage and cardiovascular events. We investigated prevalence and predictors of those blood pressure phenotypes in very elderly treated hypertensives. Design and method: Office blood pressure evaluation (simultaneous bilateral brachial blood pressure measurements in supine position and then after 2 minutes of standing) and 24-h ambulatory blood pressure monitoring (ABPM) were performed with a validated oscillometric cuff-based device iin 67 treated hypertensive subjects older than 80 years (mean age 84.1 ± 3.1 years, 25.5% male, mean office brachial SBP 134.8 ± 23.2 mm Hg). Patients with left ventricular ejection fraction < 40% and severe comorbidities were not included. Orthostatic hypotension (OH) was defined as a decrease in SBP of at least 20 mm Hg upon standing and orthostatic hypertension (OHT) as a corresponding increase. Results: The prevalence of MHT was 47.7% in the entire study population and 71.1% among patients with office-controlled hypertension (BP < 150/90 mm Hg). 78.2% patients with MHT had isolated nocturnal hypertension. Orthostatic reaction was abnormal in 34.3% subjects: 22.4% participants had OH while incidence of OHT was 11.9%. OHT was significantly associated with MHT (RR = 1.7, 95% CI = 1.14–2.78). Conclusions: OHT is predictive for MHT in the very elderly treated hypertensives. Evaluation of orthostatic reaction in very elderly may help to detect a population that would benefit from ABPM.

LB.01.23] BLOOD PRESSURE AND VASCULAR PHENOTYPE IN CHILDREN AND ADOLESCENTS WITH SICKLE/BETA-THALASSEMIA

Objective: Blood pressure (BP) in patients with sickle cell disease has been reported to be lower than in the general population. Despite low BP, sickle cell disease is associated with increased risk of cardiovascular disease. The aim of the present study was to investigate the prevalence of BP phenotypes and possible differences in arterial stiffness in pediatric patients with sickle/beta thalassemia (S/b-thal) compared with matched controls. Design and method: We included in the study 16 pediatric S/b-thal patients and 16 controls matched for age and sex. Controls were otherwise healthy children and adolescents visiting our hypertension center for suspected hypertension. All patients underwent ambulatory BP monitoring and measurement of carotid-femoral pulse wave velocity (cf-PWV). Results: Mean age of the study population was 13.30 ± 4.63 years (34.4% boys). Despite lower office systolic BP levels (115.43 ± 10.03 vs. 123.37 ± 11.92 mmHg, S/b-thal vs. controls, P = 0.05), there was no statistical significant difference in 24 h, daytime and nighttime BP. Twenty five % of the S/b-thal patients and 43.8% of the controls presented office hypertension (P = NS), while 18.8% of the S/b-thal patients and 25% of the controls presented hypertension by ambulatory BP levels (P = NS). All S/b-thal patients with office hypertension presented normal ambulatory BP values (white-coat hypertension). None of the S/b-thal patients had daytime hypertension, while all 18.8% presented nighttime hypertension with office normotension < 90th percentile (masked hypertension). S/b-thal patients and controls presented equal prevalence of masked hypertension (19%). S/b-thal patients presented also similar levels of cf-PWV with controls (7.1 ± 1.25 vs. 7.25 ± 1.43 m/sec, P = NS) and an 18.8% of the patients presented cf-PWV levels above the 95th pc for age and sex. Conclusions: Children and adolescents with S/b-thal present similar prevalence of BP phenotypes and levels of cf-PWV with pediatric population referred for suspected hypertension. A significant number of children and adolescents with S/b-thal may have nighttime hypertension despite normal office BP levels.

OP.6A.04] HIGH PREVALENCE OF MASKED UNCONTROLLED HYPERTENSENSION AMONG TREATED PATIENTS FOLLOWED UNDER ROUTINE CANADIAN CLINICAL CARE

Objective: Masked hypertension (MH), defined as elevated ambulatory blood pressure (BP) among patients with seemingly well controlled office blood pressure measurements (OBPM), has been associated with high cardiovascular risk. Previous studies have reported a MH prevalence between 10% to 30%, mostly among untreated individuals. The main objective of this study was to describe the prevalence of MH in borderline controlled hypertensive patients treated with short-acting antihypertensives in Canadian routine clinical care. Furthermore, differences between OBPM and home BP measurements (HBPM) taken 24-hours after last medication dose were assessed in treated hypertensive patients with borderline and almost controlled BP. Design and method: Real-life, prospective Canadian study conducted in general practitioners’ offices. Enrolled patients had borderline (SBP 130–139 and/or DBP 80–89 mmHg) or almost controlled (SBP 140–149 and/or DBP 90–99 mmHg) BP based on OBPM and were treated with short-acting antihypertensives. Patients collected HBPMs for 7 consecutive days. MH was defined as HBPM SBP > = 135 and/or DBP > = 85 mmHg among borderline controlled patients. Results: 983 patients were included; 370 (37.6%) were borderline controlled and 613 (62.4%) were almost controlled. Mean (SD) age was 60.5 (11.0) years, 50.1% were male and 65.7% were Caucasian without any remarkable differences between groups. OBPM and HBPM values are summarized in Table 1. Among patients with borderline controlled OBPM hypertension, 187 (50.5%) had MH.Conclusions: A higher rate of MH than what was previously reported in the literature was observed in this study, which confirms previous studies suggesting that the use of short-acting antihypertensives may be a risk factor for MH, probably due to suboptimal coverage over 24 hours. These results support the latest Canadian Hypertension Education Program recommendations that OBPM alone is inadequate for BP control optimization.

Predicted Atherosclerotic Cardiovascular Disease Risk and Masked Hypertension Among Blacks in the Jackson Heart Study.

Among individuals without hypertension based on clinic blood pressure (BP), it is unclear who should be screened for masked hypertension, defined as having hypertension based on out-of-clinic BP. We hypothesized that individuals with a higher 10-year predicted atherosclerotic cardiovascular disease (ASCVD) risk, calculated using the pooled cohort risk equations, have a higher prevalence of masked hypertension. We analyzed data from the Jackson Heart Study-a population-based cohort of blacks-to determine the association of predicted ASCVD risk with masked hypertension. The sample included 644 participants, 40 to 79 years of age, with clinic systolic/diastolic BP <140/90 mm Hg, who completed ambulatory BP monitoring, were free of cardiovascular disease, and had data on factors needed to calculate ASCVD risk. Ten-year predicted ASCVD risk was calculated using the pooled cohort risk equations. Any masked hypertension was defined as masked daytime hypertension (mean daytime systolic/diastolic BP ≥135/85 mm Hg), masked nighttime hypertension (mean nighttime systolic/diastolic BP ≥120/70 mm Hg), or masked 24-hour hypertension (mean 24-hour systolic/diastolic BP ≥130/80 mm Hg). The prevalence of any masked hypertension was 54.0%. Compared with participants in the lowest (<5%) predicted ASCVD risk category, multivariable-adjusted prevalence ratios (95% confidence interval) for any masked hypertension were 1.36 (1.03-1.79), 1.62 (1.22-2.16), and 1.91 (1.47-2.48) for those with ASCVD risk of 5% to <7.5%, 7.5% to <10%, and ≥10%, respectively. The C statistic for discriminating between participants with versus without any masked hypertension was 0.681 (95% confidence interval, 0.640-0.723) for ASCVD risk and 0.703 (95% confidence interval, 0.663-0.744) for clinic systolic BP and diastolic BP. Higher ASCVD risk was associated with an increased prevalence of masked hypertension. Although the discrimination of ASCVD risk for masked hypertension was not superior to clinic BP, risk prediction equations may be useful for identifying the subgroup of individuals with both masked hypertension and high predicted ASCVD risk.

Utility of ambulatory blood pressure monitoring for the management of hypertension.

Hypertension is a leading cause of cardiovascular morbidity and mortality, affecting nearly 80 million individuals in the United States alone. Accurate measurement of blood pressure (BP) is the crucial first step to reduce the associated cardiovascular risk of hypertension. For decades, clinicians have relied on office BP measurements for the diagnosis and subsequent management of hypertension. However, it has been clearly demonstrated that ambulatory BP measurements are a better predictor of cardiovascular risk and can provide clinicians with important additional information to improve BP control and reduce cardiovascular risk. This article reviews the available data and provides clinical insights into the use of ambulatory BP monitoring for the management of hypertension. Ambulatory BP monitoring is uniquely capable of identifying patients with white-coat hypertension (WCH), masked hypertension and abnormal nocturnal BP profiles. Recently, ambulatory BP data have demonstrated the negative impact of WCH on right ventricular function, a greater prevalence of masked hypertension than previously recognized and the detrimental impact of nocturnal hypertension even in controlled hypertension. Ambulatory BP monitoring provides clinicians with the most comprehensive evaluation of hypertension and the ability to define individual BP phenotypes. Hence, these out-of-office measurements can be utilized to improve hypertension control, translating into a reduction of cardiovascular events.

Masked hypertension and effort-reward imbalance at work among 2369 white-collar workers.

Hypertension is an important risk factor of cardiovascular diseases, the leading cause of death worldwide. Adverse effects of psychosocial factors at work might increase the risk of masked hypertension, but evidences are still scarce. The objective of this study is then to determine whether adverse psychosocial work factors from the effort-reward imbalance (ERI) model are associated with the prevalence of masked hypertension in a population of white-collar workers. White-collar workers were recruited from three public organizations. Blood pressure was measured at the workplace for manually operated measurements (mean of the first three readings taken by a trained assistant) followed by ambulatory measurements (mean of all subsequent readings taken during the working day). Masked hypertension was defined as manually operated BP<140/90 mm Hg and ambulatory BP ⩾135/85 mm Hg. ERI exposure at work was measured using Siegrist's validated questionnaire. Blood pressure readings were obtained from 2369 workers (participation proportion: 85%). ERI exposure (OR: 1.53 (95% CI: 1.16-2.02) and high efforts at work (OR: 1.61 (95% CI: 1.13-1.29) were associated with masked hypertension, after adjusting for sociodemographic and cardiovascular risk factors. Workers exposed to an imbalance between efforts spent at work and reward had a higher prevalence of masked hypertension. High efforts at work might be of particular importance in explaining this association. Future studies should be designed to investigate how clinicians can include questions on psychosocial work factors to screen for masked hypertension and how workplace interventions can decrease adverse psychosocial exposures to lower BP.

Prevalence of Masked Hypertension Among US Adults With Nonelevated Clinic Blood Pressure.

Masked hypertension (MHT), defined as nonelevated blood pressure (BP) in the clinic setting and elevated BP assessed by ambulatory monitoring, is associated with increased risk of target organ damage, cardiovascular disease, and mortality. Currently, no estimate of MHT prevalence exists for the general US population. After pooling data from the Masked Hypertension Study (n=811), a cross-sectional clinical investigation of systematic differences between clinic BP and ambulatory BP (ABP) in a community sample of employed adults in the New York City metropolitan area (2005-2012), and the National Health and Nutrition Examination Survey (NHANES; 2005-2010; n=9,316), an ongoing nationally representative US survey, we used multiple imputation to impute ABP-defined hypertension status for NHANES participants and estimate MHT prevalence among the 139 million US adults with nonelevated clinic BP, no history of overt cardiovascular disease, and no use of antihypertensive medication. The estimated US prevalence of MHT in 2005-2010 was 12.3% of the adult population (95% confidence interval: 10.0, 14.5)-approximately 17.1 million persons aged ≥21 years. Consistent with prior research, estimated MHT prevalence was higher among older persons, males, and those with prehypertension or diabetes. To our knowledge, this study provides the first estimate of US MHT prevalence-nearly 1 in 8 adults with nonelevated clinic BP-and suggests that millions of US adults may be misclassified as not having hypertension.

Cardiovascular Risk Factors and Masked Hypertension: The Jackson Heart Study.

Masked hypertension is associated with increased risk for cardiovascular disease. Identifying modifiable risk factors for masked hypertension could provide approaches to reduce its prevalence. Life's Simple 7 is a measure of cardiovascular health developed by the American Heart Association that includes body mass index, physical activity, diet, cigarette smoking, blood pressure (BP), cholesterol, and glucose. We examined the association between cardiovascular health and masked daytime hypertension in the Jackson Heart Study, an exclusively African American cohort. Life's Simple 7 factors were assessed during a study visit and categorized as poor, intermediate, or ideal. Ambulatory BP monitoring was performed after the study visit. Using BP measured between 10:00 am and 8:00 pm on ambulatory BP monitoring, masked daytime hypertension was defined as mean clinic systolic BP/diastolic BP <140/90 mm Hg and mean daytime systolic BP/diastolic BP ≥135/85 mm Hg. Among the 758 participants with systolic BP/diastolic BP <140/90 mm Hg, 30.5% had masked daytime hypertension. The multivariable-adjusted prevalence ratios for masked daytime hypertension comparing participants with 2, 3, and ≥4 versus ≤1 ideal Life's Simple 7 factors were 0.99 (95% confidence interval [CI], 0.74-1.33), 0.77 (95% CI, 0.57-1.03), and 0.51 (95% CI, 0.33-0.79), respectively. Masked daytime hypertension was less common among participants with ideal versus poor levels of physical activity (ratio, 0.74; 95% CI, 0.56-1.00), ideal or intermediate levels pooled together versus poor diet (prevalence ratio, 0.73; 95% CI, 0.58-0.91), ideal versus poor levels of cigarette smoking (prevalence ratio, 0.61; 95% CI, 0.46-0.82), and ideal versus intermediate levels of clinic BP (prevalence ratio, 0.28, 95% CI, 0.16-0.48). Better cardiovascular health is associated with a lower preva lence of masked hypertension.

Clinical Implications

HomeHypertensionVol. 68, No. 6Clinical Implications Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBClinical Implications Originally published1 Dec 2016https://doi.org/10.1161/HYPERTENSIONAHA.116.08492Hypertension. 2016;68:1321Cardiovascular Health and Masked Hypertension (p 1475)Download figureDownload PowerPointPrevious data from the Jackson Heart Study indicate that the prevalence of masked hypertension exceeds 50% in African Americans. Masked hypertension is associated with 2× the risk for cardiovascular disease. Data suggest that individuals with prehypertension have a high probability of having prevalent masked hypertension. Despite the importance of masked hypertension on cardiovascular outcomes, there have been few studies investigating risk factors for masked hypertension. Identifying modifiable risk factors for masked hypertension may provide an approach to prevent its development and reduce its prevalence. In the current study, Bromfield et al report that better cardiovascular health (ideal levels of body mass index, physical activity, nonsmoking, diet, clinic blood pressure, total cholesterol, and fasting glucose) was associated with a lower prevalence of masked daytime, nighttime, and 24-hour hypertension, and any masked hypertension were less prevalent among participants with. These results provide evidence that improving and maintaining cardiovascular health may lower the probability of having masked hypertension in African Americans. Although randomized clinical trials are needed to determine the efficacy of lifestyle interventions on delaying or preventing masked hypertension, clinicians should continue to encourage their patients to improve their cardiovascular risk factors through lifestyle modification, specifically by improving physical activity and diet and stopping cigarette smoking that can result in lower clinic blood pressure levels and maintain better cardiovascular health.Fetal Imprinted Genes and Maternal Blood Pressures (p 1459)Download figureDownload PowerPointEpidemiological studies suggest that gestational hypertension has both environmental and genetic pathogenic components. Defining its genetic risk factors may lead to improvements in pregnancy risk assessment and novel therapeutic targets. Known maternal genetic risk variants only account for a small fraction of the total genetic risk of gestational hypertension. The fetal genome may also contribute to that risk. Petry et al tested fetal variants in imprinted genes for associations with maternal blood pressure in pregnancy because these genes are thought to mediate the separate reproductive genetic needs of each parent. Using 2 birth cohorts from Cambridge, United Kingdom, they found 7 variants that were significantly associated with maternal blood pressure in the second half of pregnancy. In meta-analyses with additional independent data from the Hyperglycemia and Adverse Pregnancy Outcome Study, one of these variants, maternally transmitted fetal rs10139403, was associated with maternal mean arterial blood pressure at the genome-wide level—the first such finding of its kind. A composite fetal imprinted gene allele score constructed from the 7 key variants was associated with both maternal mean arterial blood pressure in the second half of pregnancy at the genome-wide level (explaining up to 8.7% of its variance) and gestational hypertension (each additional risk allele contributing an additional 50% to the risk). These data support the concept that fetal imprinted genes are related to the development of gestational hypertension.Medication Use in Resistant Hypertension, 2008 to 2014 (p 1349)Download figureDownload PowerPointCurrent recommendations for treatment-resistant hypertension (TRH) include optimizing medical therapy such as thiazide diuretics and aldosterone antagonists. But the extent to which such recommendations have been implemented is not well studied, and little is known about longitudinal trends in antihypertensive use, generally, among patients with TRH. We analyzed antihypertensive use in US adults (aged 18–65 years) with apparent TRH, defined as the concurrent use of ≥4 antihypertensive agents, from July 2008 to December 2014 using Marketscan commercial claims data. Over this time period, thiazide diuretic use was generally stable and prevalent in >80% of TRH episodes. Hydrochlorothiazide predominated among thiazides for all time periods, whereas chlorthalidone use increased modestly from 3.8% to 6.3% of all TRH episodes from 2008 to 2014. Aldosterone antagonist prevalence increased by 2.9% (7.3%–10.2%) over the same time period, driven almost exclusively by greater spironolactone use (Figure). Likewise, dihydropyridine calcium channel blocker and β-blocker use increased over the study period, whereas angiotensin-converting enzyme inhibitor use decreased. Concurrent angiotensin-converting enzyme inhibitor and angiotensin receptor blocker use declined from 17.7% (2008) to 6.3% (2014) of TRH episodes, whereas the use of preferred 3-drug regimens (diuretic, dihydropyridine calcium channel blocker, and ACE-I or angiotensin receptor blocker, but not both) increased from 50.8% to 64.6%. Our results highlight persistent, infrequent use of recommended therapies and suggest a need for increased efforts targeting evidence-based approaches. Previous Back to top Next FiguresReferencesRelatedDetails December 2016Vol 68, Issue 6 Advertisement Article InformationMetrics © 2016 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.116.08492 Originally publishedDecember 1, 2016 PDF download Advertisement

Tacrolimus Predose Concentration Is Associated With Hypertension in Pediatric Liver Transplant Recipients.

The aim of the study was to analyze the incidence of hypertension in pediatric liver transplantation (LT) recipients using ambulatory blood pressure measurements (ABPM) and to identify factors associated with hypertension. We also investigated whether hypertension or tacrolimus predose concentration (TAC C0) was associated with increased left ventricular (LV) wall thickness. On a retrospective longitudinal base, we included 39 pediatric LT recipients. Median time since transplantation was 65 months (range: 11-183). Two consecutive ABPM were analyzed with a median time interval of 13 months. Data from echocardiographic evaluation parallel to the baseline ABPM were analyzed. All patients except 1 were prescribed tacrolimus. The median TAC C0 was 4 ng/mL (range 0.9-11.2). Univariate and multivariate logistic regression models were fitted to identify factors associated with systolic and diastolic hypertension and LV wall thickness. Twenty-two of 39 children were hypertensive at baseline and 19 of 32 were hypertensive at follow-up. At baseline 10 (26%) children had masked systolic hypertension. TAC C0 was associated with systolic (P = 0.007, Exp(B) 2.02, 95% CI 1.2-3.3) and diastolic (P = 0.044, Exp(B) 1.48, 95% CI 1.0-2.2) hypertension. LV wall thickness was increased in children after LT compared with healthy population, but it was not associated with hypertension or TAC C0. Given the high prevalence of masked hypertension, ABPM should be performed in all pediatric LT recipients. Systolic and diastolic hypertension is associated with TAC C0; therefore, children with a higher target TAC C0 require a more intensive blood pressure surveillance.

Significance of masked and nocturnal hypertension in normotensive women coursing a high-risk pregnancy.

The aim was to evaluate the prevalence of nocturnal and masked hypertension and the prognostic values of these blood pressure (BP) abnormalities in normotensive women coursing a high-risk pregnancy. The study was performed in pregnant women with 20 or more weeks of gestation coursing a high-risk pregnancy, sent to a specialized hypertension department to perform a prospective defined protocol of BP evaluation. Women with office BP at least 140/90 mmHg were excluded. An ambulatory monitoring of BP was performed to identify masked and nocturnal hypertension (defined according to the current guidelines). The adjusted risk for development of preeclampsia/eclampsia (PEEC) was estimated using logistic regression. The ability of SBP and DBP to identify risk of PEEC was estimated using area under the receiver-operating characteristic curves. Eighty-seven women (29 ± 7 years old, 30 ± 5 weeks of pregnancy) were included in this analysis. The prevalence of masked hypertension was 33.3%. Nocturnal hypertension was found in 42.5% of the women. Remarkably, 27.0% of the women with nocturnal hypertension had normal 24-h values according to ambulatory BP monitoring. Twenty-two patients developed PEEC; adjusted relative risks increased with the presence of nocturnal (odds ratio = 4.72, 95% confidence interval 1.25-19.43, P = 0.023) or masked hypertension (odds ratio = 7.81, 95% confidence interval 2.6-22.86, P = 0.001). Nocturnal SBP and DBP had the highest abilities to predict PEEC (area under the curve = 0.77 and 0.80, respectively). Masked and nocturnal hypertension are frequent findings in normotensive women coursing a high-risk pregnancy, and their presence implies an increased risk to develop PEEC.

APSH YI-05 CIGARETTE SMOKING AND MASKED HYPERTENSION IN CHINESE MEN

Objective: Cigarette smoking is associated with chronic and acute endothelial dysfunction, and hence probably also elevated out-of-clinic blood pressure. In the present study, we investigated the association between cigarette smoking and masked hypertension defined as elevated out-of-clinic pressure but normal clinic pressure. Design and method: Our study included male participants of the China Ambulatory and Home BP Registry, who underwent clinic, 24-hour ambulatory and 7-day home BP monitoring. We classified smoking status as non-smoking (never smoked), past-smoking (previously smoked but stopped for at least 1 year) and current light (1–14 cigarettes/day) and heavy smoking (≥ 15 cigarettes/day). We defined masked hypertension as a normal clinic BP (<140/90 mmHg) and an elevated 24-hour ambulatory (≥ 130/80 mmHg) or home BP (≥ 135/85 mmHg). Results: The 1782 male subjects had a mean age of 55.3 years and included 536 (30.1%) current smokers. The prevalence of masked hypertension on 24-hour ambulatory BP measurement was 18.5%, 22.6%, 25.1% and 24.4% in non-smokers (n = 936), past smokers (n = 310), and current light (n = 473) and heavy smokers (n = 63), respectively (P = 0.03 for trend). After adjustment for confounders, current light and heavy smokers had a significantly (P ≤ 0.03) higher risk of masked hypertension than non-smokers (odds ratio 1.47 [95% confidence interval, 1.02–2.11] and 1.67 [1.12–2.49], respectively). Similar trends were observed for masked hypertension on home BP measurement, although statistical significance was not achieved (P ≤ 0.59 for light and heavy smokers versus non-smokers). Conclusions: Cigarette smokers had elevated out-of-clinic blood pressure, and might have to be screened for masked hypertension.

PP.01.12] DIAGNOSTIC THRESHOLD OF HYPERTENSION BY HOME BLOOD PRESSURE MONITORING

Objective: Currently recommended diagnostic threshold of hypertension by home blood pressure monitoring (HBPM) is 135/85 mmHg. However, no studies have examined the validity of recommended diagnostic threshold, using ambulatory blood pressure (ABPM) as a reference method. We compared two diagnostic threshold of HBPM 135/85 mmHg and 130/80 mmHg. Design and method: Patients with blood pressure >=140/90 mmHg at the outpatient clinic, were enrolled. HBPM was performed for 7 days (triplicated morning and evening measurement). The 24-hour ABPM was performed on the 7th day. Among 319 patients, 256 (mean age 51.8 ± 9.7 years, 119 men) who had valid HBPM and 24-hour were analyzed. At least 5 days HBPM was averaged according European Society of Hypertension guidelines. Hypertension by 24-hour was defined as >=130/80 mmHg. Results: The threshold 130/80 mmHg showed higher diagnostic sensitivity (90.2 vs 77.1%, p = 0.001), diagnostic agreement (84.8 vs 77.3%) and Kappa statistics (0.526 vs 0.439), compared to threshold 135/85 mmHg. Diagnostic specificity was not different. The prevalence of masked hypertension was more prevalent in threshold 135/85 mmHg compared to 130/80 mmHg (18.4 vs 7.8%, respectively, p = 0.025). The prevalence of white-coat hypertension was not different (4.3 vs 7.4%, respectively, p = 0.128).Conclusions: Lowering of diagnostic threshold of HBPM from 135/85 mmHg to 130/80 mmHg may be better in the diagnosis of hypertension.