Prevalence Of Masked Hypertension Research Articles

Once versus twice daily antihypertensive medications for the control of nocturnal blood pressure: a comparative study

BackgroundBlood pressure (BP) shows short-term variability within the 24 h, which can only be assessed with 24-h ambulatory blood pressure monitoring (ABPM). It is of utmost importance to control BP throughout the night to reduce incidence of hypertension complications. The purpose of this study is to evaluate the effect of timing and frequency of antihypertensive medications on the average nighttime and 24-h blood pressure control.ResultsThe study enrolled 199 hypertensive patients with controlled office blood pressure; 135 (67.8%) patients were on once daily antihypertensive medication (group 1) while 64 (32.2%) patients were on twice daily doses (group 2). The mean office SBP was 128.7 ± 7.8 mmHg in group 1 vs 129.6 ± 6.6 mmHg in group 2, (p = 0.421). ABPM readings for both groups were as follows: mean daytime SBP was 125.4 ± 11.6 mmHg vs 130.1 ± 12.9, p = 0.011; mean nighttime SBP was 117.0 ± 12.4 mmHg vs 123.1 ± 13.9 mmHg, p = 0.002, and mean 24-h SBP was 122.7 ± 10.6 mmHg vs 127.5 ± 12.0, p = 0.005. The prevalence of non-dipping was 68.9% in group 1 vs 70.3% in group 2 patients, p = 0.8 (the mean dipping ratio was 0.93 ± 0.08 in group 1 vs 0.95 ± 0.07 in group 2, p = 0.198). The prevalence of masked hypertension was higher in group 2 (28.1% vs 43.8%, p = 0.029).ConclusionTaking an extra antihypertensive pill at night did not show a decrease in the nighttime or the average 24H blood pressure in hypertensive patients with controlled office BP. On the contrary, patients who used twice daily antihypertensive medications seem to have higher nighttime and 24-h SBP, although the dipping ratio was comparable in both groups.

Abstract P173: The Impact of Asleep Blood Pressure on the Prevalence of Masked Hypertension by Race/ethnicity: Analysis of Pooled Population- and Community-based Studies

Introduction: Masked hypertension is defined as having hypertensive blood pressure (BP) outside of the office setting among adults with non-hypertensive BP when measured in the office. Some guidelines recommend defining out-of-office BP using awake measurements while other guidelines recommend using awake and asleep measurements. Hypothesis: We hypothesized that defining masked hypertension using the awake and asleep BP measurements would increase the prevalence of masked hypertension compared to using the awake period alone, and the magnitude of this difference would be greater among non-Hispanic blacks compared with non-Hispanic whites and Hispanics. Methods: We pooled previously collected data from 5 NHLBI-funded population- and community-based studies including the Jackson Heart Study, the Coronary Artery Risk Development in Young Adults Study (total participants: 2,866). All participants had office systolic BP (SBP)<140mmHg and diastolic BP (DBP)<90mmHg and underwent ambulatory BP monitoring (ABPM) for 24 hours. Hypertensive awake BP was defined as SBP ≥135mmHg or DBP ≥85mmHg while awake, hypertensive asleep BP as SBP ≥120mmHg or DBP ≥70mmHg while asleep and hypertensive 24-hour BP as SBP ≥130mmHg or DBP ≥80mmHg over the entire ABPM period. Results: The prevalence of masked hypertension increased from 29% to 43% when defined using awake, asleep, or 24-hour BP versus using awake BP alone (Table). This increase was larger in non-Hispanic blacks (31-54%) compared with non-Hispanic whites (28-37%) and Hispanics (17-26%). The adjusted prevalence ratio (95% confidence interval) for having masked hypertension for non-Hispanic blacks compared with Non-Hispanic whites was higher from 1.20(1.05,1.37) to 1.33(1.20,1.47) when defined using awake, asleep and 24-hour BP versus awake BP only. Conclusions: Including asleep BP to define masked hypertension increased the prevalence of masked hypertension to a larger extent among non-Hispanic blacks compared to non-Hispanic whites and Hispanics.

Phenotypes of masked hypertension: Isolated ambulatory, isolated home and dual masked hypertension.

Masked hypertension (MH) is defined as normal office blood pressure (OBP) and elevated ambulatory (ABP) or home blood pressure (HBP). This study assessed MH identified by each of these two methods. A retrospective analysis of cross-sectional data in treated and untreated adults from Greece, Finland and UK who had OBP, HBP and 24-h ABP measurements was performed. Dual MH was defined as normal OBP and elevated HBP and ABP, isolated ambulatory MH as normal OBP and HBP and elevated ABP and isolated home MH as normal OBP and ABP and elevated HBP. Of 1971 participants analyzed, 445 (23%) had MH on ABP and/or HBP (age 57.1 ± 10.8 years, men 55%, treated 49%). Among participants with any MH, 215 had dual MH (48%), 132 isolated ambulatory MH (30%) and 98 isolated home MH (22%). Moreover, 55% had high-normal, 35% normal and 10% optimal OBP. In logistic regression analysis isolated ambulatory MH was predicted by younger age (OR 0.35, P < 0.01 per 10 years increase), whereas isolated home MH was predicted by older age (OR 2.05, P < 0.01 per 10 years increase). Masked hypertension diagnosed by ABP and not HBP monitoring or the reverse is not uncommon. Age appears to be the most important determinant of isolated ambulatory or home MH, with the former being more common in younger participants and the latter in older ones. Only half of participants with MH have high-normal OBP, whereas the rest have lower levels.

Prevalence and determinants of Masked Hypertension among obese individuals at the Yaoundé Central Hospital: A cross-sectional study in sub-Saharan Africa

Several studies on the prognosis of masked hypertension suggest that it portends risks for cardiovascular morbidity and mortality that are comparable to the risks of sustained hypertension. obese individuals could have an increased risk of developing masked hypertension, data on the topic are scarce in our context. The aim of this study was to investigate the prevalence and associated factors of masked hypertension in obese patients in Yaoundé. We carried out a cross-sectional study from January to September 2017 at the National Obesity Center of the Yaoundé Central Hospital. Masked hypertension was defined when the mean 24-hour Systolic Blood Pressure was greater than or equal to 130 mmHg and/or the mean 24 hour Diastolic Blood Pressure was greater than or equal to 80 mmHg with normal office blood pressure. Logistic regression was used to examine the relationship of masked hypertension with associated factors. Among the 90 participants included, 67.8% were females. Mean age (± SD) was 46 (± 8) years. The mean clinical measurements were 120 ± 9.4 mm Hg and 75.5 ± 7.9 mm Hg respectively for the systolic and the diastolic blood pressure. On 24-hour Ambulatory measurement, the mean was 123.9 ± 14.4/74.7 ± 8.9 mm Hg respectively for the systolic/diastolic blood pressure. The prevalence of masked hypertension was 33.3%. Masked hypertension was significantly associated with high-normal office blood pressure [odds ratio (OR) =2.90, P = 0.02] and to dyslipidemia [OR = 3.60, P = 0.01], but not to male sex, diabetes, physical activity, tobacco/alcohol. Our findings suggest that the prevalence of masked hypertension is high and that physicians should consider ambulatory blood pressure monitoring for obese individuals with high-normal office blood pressure and/or dyslipidemia.

Long Working Hours and the Prevalence of Masked and Sustained Hypertension.

Previous studies on the effect of long working hours on blood pressure have shown inconsistent results. Mixed findings could be attributable to limitations related to blood pressure measurement and the lack of consideration of masked hypertension. The objective was to determine whether individuals who work long hours have a higher prevalence of masked and sustained hypertension. Data were collected at 3-time points over 5 years from 3547 white-collar workers. Long working hours were self-reported, and blood pressure was measured using Spacelabs 90207. Workplace clinic blood pressure was defined as the mean of the first 3readings taken at rest at the workplace. Ambulatory blood pressure was defined as the mean of the next readings recorded every 15 minutes during daytime working hours. Masked hypertension was defined as clinic blood pressure < 140/90 mm Hg and ambulatory blood pressure ≥135/85 mm Hg. Sustained hypertension was defined as clinic blood pressure ≥140/90 mm Hg and ambulatory blood pressure ≥135/85 mm Hg or being treated hypertension. Long working hours were associated with the prevalence of masked hypertension (prevalence ratio 49+=1.70 [95% CI, 1.09-2.64]), after adjustment for sociodemographics, lifestyle-related risk factors, diabetes mellitus, family history of cardiovascular disease, and job strain. The association with sustained hypertension was of a comparable magnitude (prevalence ratio 49+=1.66 [95% CI, 1.15-2.50]). Results suggest that long working hours are an independent risk factor for masked and sustained hypertension. Workplace strategies targeting long working hours could be effective in reducing the clinical and public health burden of hypertension.

Sex differences in masked hypertension: the Coronary Artery Risk Development in Young Adults study.

To evaluate the association of sex with masked hypertension, defined by out-of-clinic hypertension based on ambulatory blood pressure monitoring (ABPM) among adults without hypertension based on blood pressure (BP) measured in the clinic, after adjusting for potential confounders. We evaluated sex differences in the prevalence of masked hypertension and the difference between awake, or alternatively 24-h, ambulatory BP and clinic BP using multivariable adjusted models among 658 participants who underwent 24-h ABPM and had clinic SBP/DBP less than 140/90 mmHg during the Year 30 Exam of the Coronary Artery Risk Development in Young Adults study. The mean age ± standard deviation (SD) of the participants was 54.8 ± 3.7 years, 58.4% were women, and 58.2% were black. The prevalence of any masked hypertension was 37.5% among women and 60.6% among men. In a model including adjustment for demographics, cardiovascular risk factors, antihypertensive medication, and clinic BP, the prevalence ratios (95% confidence intervals) comparing men versus women were 1.39 (1.18-1.63) for any masked hypertension, and 1.60 (1.28-1.99), 1.71 (1.36-2.15), and 1.40 (1.13-1.73) for masked awake, 24-h and asleep hypertension, respectively. In a fully adjusted model, the differences between mean awake ambulatory BP and clinic BP were 2.75 [standard error (SE) 0.92] mmHg higher for SBP and 3.61 (SE 0.58) mmHg higher for DBP among men compared with women. The prevalence of masked hypertension on ABPM was high in both men and women. Male sex was an independent predictor of masked hypertension.

Highlights of the December issue.

Highlights of the December issue.

Blood pressure related to age: The India ABPM study.

The present paper reports trends in office blood pressure (BP) measurement (OBPM) and ambulatory blood pressure measurement (ABPM) with age in a large multi-center Indian all comers' population visiting primary care physicians. ABPM and OBPM data from 27472 subjects (aged 51±14years, males 68.2%, treated 45.5%) were analyzed and compared. Individual differences between OBPM and ABPM patterns were compared for patients according to 10-year age categories. Results showed that systolic (S) BP values started to increase with age from the age of 40, BP variability (SD) increased from the age of 30years. Diastolic (D) BP values started to decrease from the age of 50years. Mean OBPM values were higher than daytime ABPM values (all P<.001) in all age-groups. The prevalence of white coat hypertension (WCH) and masked hypertension (MH) was based on OBPM and daytime, 24-hour, and nighttime average BPs together. WCH decreased with age from 15.1% and 12.4% in treated and untreated subjects at the youngest age to 7.2% and 6.9% in the oldest age, respectively. MH prevalence was higher for untreated than for treated subjects but remained similar for all age-groups (range of 18.6%-21.3%). The prevalence of reverse dippers increased with age from the youngest to oldest group with 7.3%-34.2% (P<.001 for trend). Dippers prevalence decreased from 42.5% to 17.9% from the youngest to oldest age-groups, respectively (P<.001 for trend). These findings confirm that BP patterns show clear differences in trends with age, particularly regarding nighttime BP.

P800Proposal of an algorithm for the diagnosis of hypertension by using out-of-office blood pressure measurements

Abstract Background and purpose Based on the data of patients who measured office BP (OBP) in controlled condition, home BP (HBP), and 24-hour ambulatory BP (24hABP) for diagnosis of hypertension, we developed and validated a diagnostic algorithm for hypertension. Methods Patients who have high BP (≥140/90 mmHg) at the outpatient clinic were referred to measure OBP in controlled condition, HBP and 24hABP. The OBP was measured three times at each visit for 3 days in controlled condition by using a validated oscillometric device. HBP was measured for 7 days in triplicates every morning and evening. The 24hABP was measured on the 8th day. Same study protocol was used for development and validation population. Results In the development of algorithm, 319 patients were recruited and data of 256 patients (51.8±9.7 years, 119 men) with valid HBP and 24hABP measurements were analyzed. In the validation of algorithm, 300 patients were recruited and data of 257 patients (52.4±9.8 years, 126 men) with valid HBP and 24hABP measurements were analyzed. In the development population, the prevalence of masked hypertension was 19.5% (n=50) and most of them (n=47, 94%) was in the range of 130–139/80–89 mmHg. The BP in the range of 130–144/80–94 mmHg was defined as the grey zone of OBP, because prevalence of white-coat hypertension was lowered to 1.6% from 4.3% with threshold of 145/95 mmHg. The diagnostic sensitivity, specificity, positive and negative predictive value of OBP was improved to 97.4%, 76.5, 96.5% and 81.3% after excluding the grey zone of OBP (n=125). The diagnostic agreement between 24hABP and HBP in the grey zone of OBP was 64%. The diagnostic sensitivity, specificity, positive and negative predictive value of HBP were 88.8%, 74.7, 93.5% and 61.5% after excluding the grey zone of HBP (130–134/80–84 mmHg, n=28). Based upon these results, we developed a diagnostic algorithm for hypertension by using on out-of-office BP measurements to improved diagnostic accuracy of hypertension (Figure). In the validation population, the developed algorithm showed similar diagnostic accuracy. Diagnostic algorithm for hypertension Conclusion For accurate diagnosis of hypertension, OBP measurement according to guidelines and 24hABP measurement to grey zone of OBP is preferred. To improve diagnostic accuracy of HBP measurement, 24hABP measurement to grey zone of HBP is required. Acknowledgement/Funding Part of this study was supported by a grand from Dong-A ST Co. Ltd., Seoul, Korea.

Expert panel consensus recommendations for ambulatory blood pressure monitoring in Asia: The HOPE Asia Network.

Hypertension is an important public health issue because of its association with a number of significant diseases and adverse outcomes. However, there are important ethnic differences in the pathogenesis and cardio-/cerebrovascular consequences of hypertension. Given the large populations and rapidly aging demographic in Asian regions, optimal strategies to diagnose and manage hypertension are of high importance. Ambulatory blood pressure monitoring (ABPM) is an important out-of-office blood pressure (BP) measurement tool that should play a central role in hypertension detection and management. The use of ABPM is particularly important in Asia due to the specific features of hypertension in Asian patients, including a high prevalence of masked hypertension, disrupted BP variability with marked morning BP surge, and nocturnal hypertension. This HOPE Asia Network document summarizes region-specific literature on the relationship between ABPM parameters and cardiovascular risk and target organ damage, providing a rationale for consensus-based recommendations on the use of ABPM in Asia. The aim of these recommendations is to guide and improve clinical practice to facilitate optimal BP monitoring with the goal of optimizing patient management and expediting the efficient allocation of treatment and health care resources. This should contribute to the HOPE Asia Network mission of improving the management of hypertension and organ protection toward achieving "zero" cardiovascular events in Asia.

SEASONAL VARIATION IN PREVALENCE OF MASKED UNCONTROLLED HYPERTENSION IN GENERAL PRACTICE OUTPATIENTS

Objective: Masked hypertension is generally known as a cardiovascular disease (CVD) risk factor at a same level comparable to sustained hypertension. However, there is no data on seasonal differences in the prevalence of masked hypertension in outpatients under hypertensive treatment in clinical practice. We thus assessed seasonal variation in prevalence of masked uncontrolled hypertension using dataset of the Japan Morning Surge-Home Blood Pressure (J-HOP) study. Design and method: The J-HOP study is a nation-wide prospective observational study to predict CVD events in clinical practice outpatients, and participants underwent home blood pressure (BP) measurements in the morning and evening for a 14-day period. Clinic and home BP levels, prevalence of masked uncontrolled hypertension were compared in participants divided by seasons when they measured HBP. Masked uncontrolled hypertension was defined as clinic BP < 140/90 mmHg and morning or evening home BP > 135/85 mmHg based on the current Japanese guideline. Results: Among 4271 participants (mean age, 64.9 ± 10.9 years; 47.0% male; 91.4% hypertensive patients, 67 institutions in various areas in Japan), morning home systolic BP was significantly lower in summer compared to other seasons (spring, 139.4 ± 15.5 mmHg; summer, 134.1 ± 15.6 mmHg; autumn, 139.4 ± 16.1 mmHg; winter, 140.3 ± 15.5 mmHg, p value < 0.01 in all comparison between summer and other seasons). Moreover, prevalence of masked uncontrolled hypertension was significantly higher in winter that that in summer (spring, 22.5%; summer, 18.1%; autumn, 22.7%; winter, 24.4%, p < 0.01 in comparison between summer and winter) (Figure). In multivariate logistic regression analysis, masked uncontrolled hypertension was lower in summer compared to spring as reference after adjusted host factors and clinic BP levels (odds ratio, 0.60; 95% confidence interval, 0.47 to 0.77, p < 0.001).Conclusions: The present study revealed prevalence of masked uncontrolled hypertension tended to be lower in summer. Measurement of home BP is thus more valuable than clinic BP for management of hypertension corresponding to changes of season.

MASKED HYPERTENSION IN NURSING PROFESSIONALS

Objective: The aims of the study were to evaluate the prevalence and factors associated with Masked Hypertension in nursing professionals. Design and method: This was a cross-sectional study of 182 nursing professionals (38.07.5 years, 82.4% women). Office blood pressure measurement and 24-hour Ambulatory Blood Pressure Monitoring (ABPM) were applied in a usual work day. An interview was conducted to evaluate biopsychosocial, related to work and life habits variables. Fasting venous blood was drawn for biochemical analysis. Masked Hypertension was defined as office blood pressure less or equal 140/90 mmHg and mean daytime ABPM greater or equal 135/85 mmHg and non-use of antihypertensive treatment. Poisson regression with robust variance was performed, with values of p < 0.05 being considered statistically significant. Results: The prevalence of Masked Hypertension was 19.8% [95% confidence interval:15.67–23.93). The characteristics of the study sample were: shift work (61.0%), referred stress (44.0%), use of alcoholic beverage (28.6%), problematic consumption of alcohol (34.6%), dyslipidemia (24.2%), high risk for diabetes (20.3%), moderate work-related stress (73.6%), common mental disorders (60.4%), poor sleep quality (91.8%), burnout (41.8%) and had no blood pressure drop during sleep (nondippers) – systolic blood pressure 40.7%, diastolic blood pressure 30.2%). The nursing professionals with masked hypertension, had significantly higher than no masked hypertension: mean 24-hour, daytime and nighttime systolic/diastolic blood pressure in the 24-hour Ambulatory Blood Pressure Monitoring. Participants with masked hypertension were more elderly (age greater or equal 30 years); were married or separated / divorced / widowed or Conjugal/common law relationship; shift work (prevalence ratio: 2.40, [95% confidence interval:1.24–4.64), using drugs to inhibit sleep (prevalence ratio: 5.25, [95% confidence interval: 2.94–9.34), problematic consumption of alcohol (prevalence ratio: 5.19, 95% confidence interval:1.73–15.55) or not consuming alcohol (prevalence ratio: 3.93, 95% confidence interval:1.49–10.38) and referred hypertension (prevalence ratio: 0.24, 95% confidence interval: 0.13–0.44). Conclusions: Nursing professionals presented a high prevalence of Masked Hypertension which was associated with hypertension, variables related to work and habits or lifestyles. The 24-hour Ambulatory Blood Pressure Monitoring should be routine in occupational health checks in health workers, especially shift workers.

PHENOTYPES OF MASKED HYPERTENSION

Objective: Out-of-office blood pressure (BP) measurement is now regarded as mandatory to identify white-coat and masked hypertension (MH). This study investigated the prevalence and predictors of MH detected by ambulatory (ABP) and/or home BP (HBP) monitoring. Design and method: A retrospective analysis of cross-sectional data in treated or untreated adults from Greece, Finland and UK was performed. Subjects who had HBP, ABP and office BP (OBP), measurements performed using the same protocol were included. Dual MH was defined as low OBP and elevated HBP and ABP (24-hour), isolated ambulatory MH as low OBP and HBP and elevated ABP and isolated home MH as low OBP and ABP and elevated HBP. Results: 1,971 subjects with complete data were analyzed. 445 subjects (23%) had MH on ABP and/or HBP (age 57.1 ± 10.8 years, males 55%, treated for hypertension 49%). Among subjects with any MH 215 had dual MH (48%), 132 isolated ambulatory MH (30%) and 98 isolated home MH (22%), while 55% had high-normal OBP, 35% normal and 10% optimal OBP. In logistic regression analysis high-normal OBP (OR 2.48, p < 0.01) predicted dual MH. Isolated ambulatory MH was predicted by younger age (OR per 10 years increase 0.67, p < 0.01), while isolated home MH was predicted by older age (OR per 10 years increase 1.42, p < 0.01). Conclusions: MH detected only by ambulatory or only by home BP monitoring is not uncommon. Age appears to be the most important determinant of isolated ambulatory or home MH, with the former being more common in younger subjects and the latter in older ones. High-normal OBP predicts only half of subjects with MH, the other having lower OBP levels.

Masked Hypertension in CKD: Increased Prevalence and Risk for Cardiovascular and Renal Events.

Hypertension and chronic kidney disease (CKD) are inextricably linked. The causal nature of the relationship is bidirectional. This relationship holds when blood pressure is assessed in the clinic and outside the clinic with home and ambulatory blood pressure monitoring. Patients with CKD are more likely to have high-risk hypertension phenotypes, such as masked and sustained hypertension, and are at increased risk for cardiovascular disease. The purpose of this review is to describe the increased prevalence of masked hypertension in patients with CKD and then describe the increased risk for target organ damage and adverse clinical events associated with masked hypertension in patients with CKD. The prevalence of masked hypertension is greater in patients with CKD than that of the general population. Recent studies have demonstrated that masked hypertension is associated with increased risk for target organ damage including left ventricular hypertrophy, elevated pulse wave velocity, proteinuria, and decreased estimated glomerular filtration rate in patients with CKD. Additionally, in patients with CKD, masked hypertension is associated with increased risk for cardiovascular disease, end-stage renal disease, and all-cause mortality. Patients with CKD are at increased risk for masked hypertension. Masked hypertension is associated with increased risk for target organ damage and adverse cardiovascular and renal outcomes in patients with CKD. Further research is necessary to better understand the pathophysiology of masked hypertension, the optimal method for diagnosing masked hypertension, and to determine whether masked hypertension is a modifiable risk factor.

Nadciśnienie tętnicze maskowane — niedoceniany problem

Masked hypertension should be defined in untreated patients, who have normal office blood pressure &lt; 140/ /90 mm Hg, with elevated out-of-office average levels in home blood pressure measurement (HBPM) or/and ambulatory blood pressure monitoring (ABPM) with a daytime BP ³ 135/85 mm Hg or nighttime BP ³ 120/70 mm Hg. Performing out-of-office blood pressure measurements is a sine qua non condition for MH diagnosis. Masked hypertension can be found in even 30% of patients with a normal office blood pressure. To detect this type of hypertension, patients with high-normal BP, should be regularly controlled. The prevalence is greater in middle age men, with high-normal BP, smokers, abusing alcohol or other drugs and with higher levels of stress. Obesity, diabetes, chronic kidney disease, obstructive sleep apnea are also associated with an increased prevalence of masked hypertension. A special form of masked hypertension, associated with increased risk of hypertensive target organ damage (HMOD), is nocturnal hypertension and non-dipping. The risk of cardiovascular events is substantially greater in masked hypertension, compared with normotension. Because of frequent occurrence HMOD and comorbidities in population with MH, they are usually high-risk patients. It was estimated, that over 35% in individuals with masked hypertension, will develop persistence hypertension. But one in five patients, in long-term observation, will have only out- -of-office elevated blood pressure, which potentially delays diagnosis and treatment, with the progressive development of HMOD. Therefore, in masked hypertension lifestyle changes and antihypertensive drug treatment are recommended. According to European Society of Hypertension/European Society of Cardiology guidelines, ABPM or HBPM is specifically recommended for clinical indications, such as identifying and control of antihypertensive treatment effect in masked hypertension.

Abstract MP65: Maternal Vascular Lesions in the Placenta May Identify Women Susceptible to Masked Hypertension a Decade After Pregnancy

Introduction: Women with placentally mediated pregnancy complications such as preeclampsia have excess hypertension and cardiovascular disease later in life, but the underlying pathophysiology linking these conditions is unknown. Hypothesis: We considered that histological examination of the placenta may reveal maternal vascular impairments that identify a group susceptible to blood pressure (BP) elevations a decade after delivery, including elevations that may only be detectable using out of office BP measurement. Method: Women with a singleton live birth at Magee-Womens Hospital (Pittsburgh, PA) during 2008-2009 were enrolled 8-10 years after delivery (n=248). Pregnancy features and placental pathology were abstracted from medical records. Women with placental vasculopathy (several related lesions arising from impaired remodeling of maternal myometrial and decidual arteries, n=24) or infarcts (n=32) were compared to women with neither lesion (n=192). Clinic BP was measured three times by trained research staff using a standard protocol and a validated home BP device. Women were trained to measure their BP twice daily for 7 days using the same device mentioned above. Subsequently, time and date stamped BP measures were downloaded (mean 12.2 measures ± 4.5). BP status (elevated, stage 1, stage 2) was identified using the 2018 ACC/AHA guidelines for clinic and home BP measures. Sustained normotensive, white coat, masked, and sustained hypertension status were classified. Results: Women were, on average, 37 years of age at measurement. In analysis controlled for age and race (p-value &lt; 0.05) those with placental vasculopathy had higher mean diastolic BP in clinic and at home (80.5 ± 13.3 mmHg, 79.9 ± 10.4, respectively) than women without vascular lesions in the placenta (75.4 ± 9.8 mmHg and 74.3 ±8.6, respectively). In addition, women with placental vasculopathy had a higher prevalence of masked hypertension (higher elevated BP status measured at home vs. in clinic; 37.5% vs. 14.1%) that persisted after accounting for maternal age and race (adjusted OR 4.7, 95% confidence interval 1.6, 13.8). Vasculopathy associations were similar after excluding women with preeclampsia (n=42), the pregnancy complication most strongly associated with placental vascular pathology. There were modest, non-significant associations between placental infarcts and all measures of maternal blood pressure. Conclusions: Irrespective of prior preecclampsia, women with placental evidence of vasculopathy have excess hypertension and particularly masked hypertension in the decade after pregnancy. Our results emphasize the value of out of office blood pressure measurement, and indicate that placental vasculopathy may be pathophysiologically related to development of hypertension before age 50.

Prevalence of Masked and White-Coat Hypertension in Pre-Hypertensive and Stage 1 Hypertensive patients with the use of TeleMRPA.

BackgroundThe diagnosis of arterial hypertension based on measurements of blood pressure in the office has low accuracy.ObjectiveTo evaluate the prevalence of masked hypertension (MH) and white-coat hypertension through home blood pressure monitoring (HBPM) in pre-hypertensive and stage 1 hypertensive patients.MethodRetrospective study, of which sample consisted of individuals with BP ≥ 120/80 mmHg and < 160/100 mmHg at the medical office without the use of antihypertensive medication and who underwent exams on the HBPM platform by telemedicine (TeleMRPA) between May 2017 and September 2018. The four-day MRPA protocol was used, with 24 measurements, using automated, validated, calibrated equipment with a memory function.ResultsThe sample consisted of 1,273 participants, of which 739 (58.1%) were women. The mean age was 52.4 ± 14.9 years, mean body mass index (BMI) 28.4 ± 5.1 kg/m2. The casual BP was higher than the HBPM in 7.6 mmHg for systolic blood pressure (SBP) and 5.2 mmHg for diastolic blood pressure (DBP), both with statistical significance (p < 0.001). There were 558 (43.8%) normotensive individuals; 291 (22.9%) with sustained hypertension; 145 (11.4%) with MH and 279 (21.9%) with white-coat hypertension (WCH), with a diagnostic error by casual BP in the total sample in 424 (33.3%) patients. In stage 1 hypertensive individuals, the prevalence of WCH was 48.9%; in prehypertensive patients, the prevalence of MH was 20.6%.ConclusionMH and WCH have a high prevalence rate in the adult population; however, in prehypertensive or stage 1 hypertensive patients, the prevalence is higher. Out-of-office BP measurements in these subgroups should be performed whenever possible to prevent misdiagnosis.

Diagnosing Masked Hypertension Using Ambulatory Blood Pressure Monitoring, Home Blood Pressure Monitoring, or Both?

Guidelines recommend measuring out-of-clinic blood pressure (BP) to identify masked hypertension (MHT) defined by out-of-clinic BP in the hypertensive range among individuals with clinic-measured BP not in the hypertensive range. The aim of this study was to determine the overlap between ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM) for the detection of MHT. We analyzed data from 333 community-dwelling adults not taking antihypertensive medication with clinic BP <140/90 mm Hg in the IDH study (Improving the Detection of Hypertension). Any MHT was defined by the presence of daytime MHT (mean daytime BP ≥135/85 mm Hg), 24-hour MHT (mean 24-hour BP ≥130/80 mm Hg), or nighttime MHT (mean nighttime BP ≥120/70 mm Hg). Home MHT was defined as mean BP ≥135/85 mm Hg on HBPM. The prevalence of MHT was 25.8% for any MHT and 11.1% for home MHT. Among participants with MHT on either ABPM or HBPM, 29.5% had MHT on both ABPM and HBPM; 61.1% had MHT only on ABPM; and 9.4% of participants had MHT only on HBPM. After multivariable adjustment and compared with participants without MHT on ABPM and HBPM, those with MHT on both ABPM and HBPM and only on ABPM had a higher left ventricular mass index (mean difference [SE], 12.7 [2.9] g/m2, P<0.001; and 4.9 [2.1] g/m2, P=0.022, respectively), whereas participants with MHT only on HBPM did not have an increased left ventricular mass index (mean difference [SE], -1.9 [4.8] g/m2, P=0.693). These data suggest that conducting ABPM will detect many individuals with MHT who have an increased cardiovascular disease risk.

A0241 Use of Ambulatory Blood Pressure Monitoring in the Diagnosis of White Coat and Masked Hypertension

Objectives: We investigated the different methods on diagnosis of white coat and masked phenomena in ambulatory blood pressure (ABP). Methods: We collected information on clinical characteristics and laboratory data, and performed measurements of OBP and ABP in 274 subjects, including 46 persons with high normal OBP, 187 untreated patients with grade 1 and grade 2 hypertension, and 41 treated hypertensive patients. The 95 and 5 percentile for the difference between OBP and daytime ABP, respectively, as the cutoff for the definition of white coat phenomenon and masked phenomenon. Results: If white coat and masked phenomenon and hypertension were diagnosed according to the current hypertension guidelines, the prevalence of white coat phenomenon did not differ between untreated and treated hypertensive patients (P = 0.46). In the untreated group, the prevalence of white coat phenomenon was higher in grade 2 than grade 1 hypertension (P = 0.033), whereas the prevalence of WCH did not differ (P = 0.23).The prevalence of masked hypertension was 73.9% in high normal BP group.The prevalence of masked uncontrolled hypertension was 4.9%. If the 95 percentile (≥20.5/20.5mmHg)and 5 percentile (≤-18.67/−6.0mmHg)for the difference between OBP and daytime ABP were, respectively, used as cutoff for the definition of white coat and masked phenomenon, the prevalence of white coat phenomenon did not differ between treated and untreated groups (P = 0.54). In the untreated group, the prevalence of white coat phenomenon was higher in grade 2 than grade 1 hypertension (P < 0.0001).The prevalence of masked phenomenon did not differ between persons with high normal OBP (15.2%) and untreated (5.9%) and treated hypertensive patients (12.2%)(P > 0.05). Conclusion: The percentile methods may be useful for the diagnosis of white coat and masked phenomena.

Prevalence of masked hypertension among children with risk factors for arterial hypertension

Masked hypertension (MH) in children is defined as normal office blood pressure values and high values outside the clinical setting. The 24-hour ambulatory blood pressure monitoring (ABPM) is helpful for diagnosis. There is little information on MH prevalence in our population. To estimate the prevalence of MH in children with risk factors for arterial hypertension. Prospective, observational, cross-sectional study. Patients seen at Hospital General de Niños "P. de Elizalde" between July 1st, 2015 and December 1st, 2016, aged 5-11 years, with normal blood pressure and at least one risk factor for arterial hypertension were included in consecutive order. A 24-hour ABPM was done (SpaceLabs 90207/90217). Estimated sample: 110 patients. All relevant authorizations were obtained. One hundred and ten patients aged 8.7 ± 1.8 years were included; 60 were girls. ABPM duration: 23.18 ± 1.8 hours. Twenty-three patients had neonatal history; all had at least one factor corresponding to personal history (the most common ones were increased salt intake and obesity); 101 had at least one factor corresponding to family history. ABPM helped to identify 10 patients with MH (9.1%; 95% confidence interval |-1;CI|-3;: 5.1-15.9); 7 had isolated nocturnal hypertension (6.4%; 95% CI: 3.1-23.5) and 28 had prehypertension (25.4%; 95% CI: 18.234.3). Among the 10 patients with MH, 7 were boys, 9 were obese and had at least one factor corresponding to family history. The prevalence of MH in children with risk factors for arterial hypertension was close to 10%.