Prevalence Of White Coat Hypertension Research Articles

Relationship between white-coat hypertension and office isolated systolic or diastolic hypertension: an ambulatory blood pressure monitoring study.

This study investigated the prevalence of white-coat hypertension (WCH) among individuals with office isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). We evaluated 9122 individuals [57.0 ± 14.5 years, 51% men] with office blood pressure ≥140/90 mmHg who underwent ambulatory blood pressure monitoring (ABPM) and were categorized into younger (<40-years), middle-aged (≥40 and <60-years) and older (≥60-years) groups. The prevalence of WCH in SDH, ISH, and IDH was 18, 61, and 37% in younger, 16, 55, and 29% in middle-aged, and 23, 51, and 40% in older individuals. Multivariable logistic regression analysis showed a higher likelihood of WCH in ISH (4.1, 3.6, and 2.1-fold all p < 0.001) and IDH (1.9, 1.5, and 1.5-fold; all p < 0.001) compared to SDH among younger, middle-aged and older individuals, respectively. These data indicate that ISH and, to a minor extent, IDH are linked to a higher prevalence of WCH derived from ABPM exams.

Hypertension in Older Frail Adults in an Integrated Care Hub -What is the Guidance for Management in this Cohort?

Abstract Background The current European Society of Hypertension (ESH, 2023) guidelines suggest specific recommendations for very old or frail patients; to maintain an office systolic blood pressure (OSBP) between 140 to 150 mmHg. A reduction of treatment could be considered in these patients with a low OSBP (&amp;lt;120 mmHg) or in the presence of severe orthostatic hypotension or a high frailty level. Methods We completed a retrospective chart review of patients 80 years and older, who were referred for frailty and a falls assessment, from November 2021 to April 2024. During the chart review we examined the OSBP recordings for these patients to examine our practice. We explored the medication profile of patients who had an OSBP &amp;lt;120mmHg and &amp;gt;150mmHg. The agents used were ACE inhibitors, Angiotensin Receptor Blockers, Calcium Channel Blockers, Beta Blockers, Diuretics and Alpha Blockers. Results The charts for 52 patients met the criteria and were retrieved for review. The average age was 87 years (range 80-96). 3/52(6%) had a SBP &amp;lt; 120mmHg. 27/52(52%) had OSBP between 120 and 149 mmHg. 22/52(42%) had an OSBP &amp;gt;150mmHg. We examined the medication profile of those patients who had an OSBP &amp;lt;120 mmHg. 2/3 patients were on three agents and 1/3 patient was on two agents. Looking at the OSBP profile of those patients who had an OSBP &amp;gt;150mmHg. 6/22(27%) patients were on three agents, 3/22(14%) were on two agents, 12/22(54%) were on one agent and 1/22(5%) were on no antihypertensive treatment. Conclusion From our data we found 6% of our patients were over treated for blood pressure while 42% had uncontrolled OSBP readings. We are conscious of deprescribing in older fallers, but further prescribing may be necessary to achieve published targets as per the ESH guidelines. Further research needs to examine the prevalence of white coat hypertension in our cohort.

To Investigate the Prevalence of White Coat Hypertension in Community Dwelling Older Adults Referred for a Falls Assessment

Abstract Background Falls and frailty are the main focus in our integrated care programme for older persons (ICPOP). Office blood pressure (OBP) measurements are commonly used in practice although out of office recordings are proven to be a better predictor of cardiovascular risk (Myers et al, 2018). The European Society of Cardiology guidelines (ESC, 2018) have proposed BP values for the classification of hypertension (HTN). Methods We retrospectively completed a chart review on older adults’ who attended ICPOP with a referral for a falls assessment from November 2021 to April 2024. OBP were obtained after the patient was in the hub for approximately one hour following their comprehensive geriatric assessment (CGA). The OBP was documented following a supine period of 5 minutes. We compared the OBP and ambulatory blood pressure monitor (ABPm) average readings to assess the prevalence of HTN based on the ESC guidelines. Results 75 charts were reviewed. 3 ABPm recordings were unsuccessful due to cognitive impairment or not tolerating the ABPm. These were excluded from the audit. No patient had hypotension on either their OBP or ABPm recordings. On their OBP recordings, 29/72 (40%) had a normal reading while 43/72 (60%) had HTN. On their ABPm 54/72 (75%) had a normal reading while 18/72 (25%) had HTN. When we looked at antihypertensive medication use in those who had a normal reading on their ABPm, 47/54 (87%) were on antihypertensive treatment. All patients with HTN on their ABPM were on antihypertensive treatment. Conclusion Our findings suggest that OBP readings greatly increase the numbers of patients diagnosed with HTN compared to ABPm (60% versus 25%). Therefore, we suggest that all patients should have an ABPm as a gold standard to falls assessment to avoid over-treating white coat HTN.

Assessing White Coat Hypertension Prevalence and Anxiety Levels Using Beck Anxiety Inventory: A Study in Outpatient Settings

This study aimed to determine the prevalence of white coat hypertension (WCH) compared to home-based blood pressure (BP) measurements and assess anxiety levels among individuals with WCH using the Beck Anxiety Inventory. An observational cross-sectional study was conducted from March 2021 to April 2022 on individuals visiting the Outpatient Departments (OPDs) of Khyber Teaching Hospital, Peshawar. In-hospital and home BP recordings were performed, and anxiety levels were assessed using the Beck Anxiety Inventory. A sample size of 213 normotensive individuals was selected using a non-probability convenience sampling technique. Data were collected using structured questionnaires, analyzed using IBM SPSS version 26 and MS Excel 2019, and presented in tables and charts. Among the 213 respondents aged 14-67 years, comprising 164 (77%) males and 49 (23%) females, 22 (10.3%) exhibited BP readings above 140/90 in the OPD, indicative of WCH, while registering normal readings below 140/90 at home. The Beck anxiety index scores of these 22 individuals revealed varying degrees of anxiety, with 2 (9.1%) classified as Minimal, 6 (27.3%) as mild, 12 (54.5%) as Moderate, and 2 (9.1%) as severe anxiety. The prevalence of WCH underscores its clinical significance in predicting prehypertension, cardiovascular diseases (CVDs), and target organ damage. However, the propensity for labile BP in clinical environments may lead to misinterpretation, prompting unnecessary pharmacological interventions and exacerbating physical, mental, and financial distress for patients. Thus, widespread education on WCH among healthcare professionals and the public is crucial. Additionally, home-based BP measurements and ambulatory BP monitoring are advocated as preferred alternatives to mitigate the potential risks associated with WCH.

WHITE-COAT AND MASKED HYPERTENSION IN HEMODIALYSIS PATIENTS

Objective: Unlike the general population or patients with earlier stages of chronic kidney disease, there are no clear diagnostic criteria for white-coat and masked hypertension in the hemodialysis population. In the present study, we aimed to estimate the prevalence of these 2 BP phenotypes using routine predialysis BP recordings in combination with 44-hour ambulatory BP monitoring (ABPM). Design and method: In a cohort of 70 hemodialysis patients, hypertension was assessed with 2 methods: (i) the average of routine predialysis BP recordings over 6 consecuitive dialysis sessions; (ii) ABPM over an entire 44-hour interdialytic period (BP measurements at 20-minute intervals; Microlife WatchBP O3 device). The thresholds of 140/90 mmHg and 130/80 mmHg were used to define abnormal predialysis and ambulatory BP, respectively. Results: Study participants (45 males and 25 females) had a mean age of 65.3±13.3 years and a median dialysis vintage of 15 months. The prevalence of hypertension was 88.6% by predialysis BP recordings and 90% by ABPM. In all, 61 patients were being treated with an average of 1.5±0.6 antihypertensive medications daily. In all, 51.4% of patients had either normotension or adequately controlled hypertension confirmed by the 2 different BP monitoring techniques, whereas 18.6% of patients had uncontrolled hypertension confirmed by both techniques. The prevalence of white-coat hypertension was 24.3% and the prevalence of masked hypertension was 5.7%. A 2-week averaged routine predialysis BP at the threshold of 140/90 mmHg provided 77.8% sensitivity and 30.8% specificity for the diagnosis of an average 44-hour ambulatory BPequal or higher than 130/80 mmHg. The agreement between these 2 techniques for the identification of patients with adequately controlled hypertension was poor (k-statistic: 0.378, P&lt;0.001). Conclusions: This study shows that in approximately 30% of hemodialysis patients, there is lack of concordance between routine predialysis BP recordings and ABPM for the determination of BP control status. Routine predialysis BP recordings, even when averaged over 6 consecutive dialysis sessions, are inaccurate estimates of the actual BP load, as assessed by ABPM.

Ambulatory Blood Pressure Monitoring versus Office Blood Pressure Monitoring to Identify the True Hypertension Status of Living Kidney Donors.

Ambulatory blood pressure monitoring (ABPM) is a reliable modality and is preferred over office blood pressure monitoring (OBPM) for detecting hypertension. However, despite its advantages, the utilization of 24-h ABPM in evaluating living kidney donors has not been universally adopted by transplant centers, partly because of the lack of data about the utility of ABPM. This study aimed to identify patients with masked and white-coat hypertension, thereby ensuring appropriate identification of their true hypertension status and assessments of the risk to donors. This study included 73 potential living kidney donors. BP was measured in the office using a standardized protocol as well as by ABPM. Detailed clinical and biochemical parameters were assessed. Target organ damage was assessed in all the donors by assessing proteinuria, hypertensive retinopathy, and echocardiography. Out of the 73 donors, 64.4% were females and 35.6% were males. The average age of individuals in our donor population was 42.0 ± 11.28 years. In total, 31.5% were detected to be hypertensive by OBPM. With ABPM, only 21.9% of donors were hypertensive. The overall prevalence of white-coat hypertension was 30.4%; that of masked hypertension was 6.0%. In donors diagnosed as hypertensive by OBPM, three individuals were identified as having target organ damage. However, two additional donors who were initially missed as hypertensive using OBPM had target organ damage. OBPM overestimated the prevalence of hypertension compared with ABPM. ABPM is the better modality in terms of diagnosing white coats and masked hypertension. ABPM also more reliably correlates with target organ damage than OBPM.

Comparison of office, home and ambulatory blood pressure measurements in hypertensive and suspected hypertensive SWICOS participants

Purpose Hypertension should be confirmed with the use of home BP measurement (HBPM) or 24h ambulatory BP measurement (ABPM). The aim of our study was to compare measurements obtained by OBPM, HBPM and ABPM in individuals with elevated OBPM participating in the population-based Swiss Longitudinal Cohort Study (SWICOS). Material and Methods Participants with OBPM ≥140/90 mmHg assessed their BP using HBPM and ABPM. The cut-off for hypertension was ≥135/85 mmHg for HBPM, ≥130/80 mmHg for ABPM. White-coat hypertension (WCH) was defined as normal HPBM and ABPM in participants not taking antihypertensive drugs. Uncontrolled hypertension was defined as hypertension in HBPM or ABPM despite antihypertensive treatment. Results Of 72 hypertensive subjects with office BP ≥140/90 mmHg and valid measurements of HBPM and ABPM, 39 were males (aged 62.8 ± 11.8y), 33 were females (aged 57.4 ± 14.2y). Hypertension was confirmed with HBPM and ABPM in 17 participants (24%), with ABPM only in 24 further participants (33%), and with HBPM only in 2 further participants (3%). Participants who had hypertension according to ABPM but not HBPM were younger (59 ± 11 y versus 67 ± 16 y; p < 0.001) and more frequently still working (83% versus 23%; p < 0.001). The prevalence of WCH was 28%. Among the 32 subjects taking antihypertensive drugs, uncontrolled hypertension was found in 49%. Conclusion This population-based study found a high prevalence of WCH and potential uncontrolled hypertension among individuals with elevated OBPM. This study, therefore, supports the ESH recommendations of complementing OBPM by ABPM or HBPM. The use of HBPM instead of ABPM for the confirmation of hypertension in individuals with elevated OBPM might lead to underdiagnosis and uncontrolled hypertension, in particular in the younger working population. In these individuals, this study suggests using ABPM instead of HBPM.

PREVALENCE OF WHITE-COAT AND MASKED HYPERTENSION AT DIFFERENT OFFICE BLOOD PRESSURE LEVELS IN UNTREATED SUBJECTS

Objective: The European Guidelines for the management of arterial hypertension support the use of out-of-office blood pressure (BP) measurements for confirming the diagnosis of hypertension and detecting BP phenotypes such as white-coat hypertension (WCH) and masked hypertension (MH), especially in patients with grade 1 hypertension and subjects with high normal BP. However, it is not clear enough, whether out-of-office blood pressure measurements should be performed in patients with higher grades of hypertension as well as in subjects with normal or optimal BP. The aim of our study was to investigate the prevalence of WCH in untreated patients with grade 1, grade 2 and grade 3 hypertension as well as the prevalence of MH in never treated subjects with high normal, normal and optimal BP values. Design and method: A total of 2357 untreated subjects referred to our Hypertension Unit for evaluation underwent 24-h ambulatory BP monitoring. According to their office BP levels were divided into 6 categories: optimal (&lt;120/80mmHg), normal (120/80 – 129/84mmHg), high normal (130/85 – 139/89mmHg), grade 1(140/90 – 159/99mmHg), grade 2 (160/100 – 179/109mmHg) and grade 3 (&gt; = 180/110mmHg). Subjects with office BP&gt; = 140/90mmHg and 24-h BP&lt;130/80mmHg were defined as WCHs and patients with office BP&lt;140/90mmHg and 24-h BP&gt; = 130/80mmHg as MHs. Statistical analysis was performed by means of chi-square test and one-way ANOVA. Results: The percentages of WCH were 53%, 31% and 24% for patients with grade 1, grade 2 and grade 3 hypertension, respectively. The percentages of MH were 34%, 29% and 17% for patients with high normal, normal and optimal BP, respectively. Conclusions: The prevalence of WCH is significantly higher in grade 1 hypertension, however patients with grade 2 and 3 hypertension present also high rates of WCH. Similarly, MH is more common in subjects with high normal BP, however high percentages are observed in subjects with normal and optimal BP. Our results support that out-of-office BP measurements should be performed across all office BP range for the optimal detection of WCH and MH.

Prevalence of masked hypertension and its association with left ventricular hypertrophy in children and young adults with chronic kidney disease: a systematic review and meta-analysis.

There are limited studies using ambulatory blood pressure monitoring (ABPM) to assess blood pressure (BP) status in young patients with chronic kidney disease (CKD) on dialysis or after kidney transplantation. The aim of this meta-analysis is to estimate the prevalence of both white-coat hypertension (WCH) and masked hypertension, along with the prevalence of left ventricular hypertrophy (LVH), in children and young adults with CKD on dialysis or after kidney transplantation. We performed a systematic review and meta-analysis of observational studies assessing the prevalence of BP phenotypes using ABPM, in children and young adults with CKD stages 2-5d. Records were identified by search in databases (Medline, Web of Science, CENTRAL) and sources of grey literature, until 31 December 2021. A random-effects meta-analysis of proportions (double arcsine transformation) was conducted. Ten studies were included in the systematic review, reporting data from 1140 individuals (children and young adults with CKD with a mean age of 13.79 ± 4.35 years). Masked hypertension and WCH were diagnosed in 301 and 76 patients, respectively. It was estimated an overall pooled masked hypertension prevalence of 27% [95% confidence interval (95% CI) 18-36, I2 = 87%] and an overall pooled WCH prevalence of 6% (95% CI 3-9, I2 = 78%). Among kidney transplant recipients, masked hypertension had a prevalence of 29% (95% CI 14-47, I2 = 86%). The prevalence of LVH was found 28% (95% CI 0.19-0.39) in a total of 238 CKD patients with ambulatory hypertension. In 172 CKD patients with masked hypertension, LVH was present in 49, with the estimated prevalence being 23% (95% CI 0.15-0.32). Masked hypertension has a significant prevalence in children and young adults with CKD. Masked hypertension carries an adverse prognosis, with an increased risk of LVH, warranting clinical attention when assessing cardiovascular risk in this population. Therefore, ABPM and echocardiography is of high importance when assessing BP status in children with CKD. 10.17605/OSF.IO/UKXAF.

PS-C07-3: PREVALENCE AND DEMOGRAPHIC PROFILE OF WHITE-COAT HYPERTENSION IN THE PATIENTS PRESENTING A TERTIARY CARE CENTER IN EASTERN NEPAL

Background: There is unequivocal evidence showing that at hospital environment BP levels are usually different from measures found at other settings. Therefore, ambulatory BP is expected to be more dependable, as well as allow the identification of a relevant subgroup of white-coat hypertension patient. Methods: This was a single center descriptive cross-sectional study conducted to assess the prevalence of white-coat hypertension among 50 participants consisting of 31 males and 19 females referred for 24 hour Ambulatory BP monitoring in B .P. Koirala Institute of Health Sciences, Dharan, Nepal, between October 2021 to December 2021. Results: The prevalence of white-coat hypertension was 19 (32%) among 50 participants, while 31(62%) of them had sustained hypertension. Prevalence of WCHTN and sustained hypertension in young age equal or less then 35 years was 4 (21.1%) and 10 (32.3%) respectively, similarly middle age 36–54 years was 13(68.4%) and 16(51.6%) and elderly equal or more then 55 years was 2(10.5%) and 5(16.1%) respectively. Most participants were of middle age group 36–54 years age. While of sex distribution pattern of WCHTN and sustained hypertension, male was 11(57.9%) and 20 (64.5%) respectively and female was 8(36.8%) and 15(48.4%) respectively. The association between the demographic variables age, sex and BMI and white-coat HTN was not statistically significant. Conclusion: The study showed that White-coat hypertension was more common in male patients and in middle age group 36–54 years, but was not statistically significant. Prevalence of white-coat hypertension was 19(38%). There was no significant association between white-coat hypertension and demographic variables.

Seasonal variation of ambulatory blood pressure in Chinese hypertensive adolescents.

Blood pressure (BP) exhibits seasonal variation with lower levels at higher temperatures and vice versa. This phenomenon affects both sexes and all age groups. So far, only a few research studies have investigated this condition in adolescents and none of them were based on hypertensive population or ever applied ambulatory blood pressure monitor (ABPM). Therefore, we carried out the first study that used ABPM to record seasonal variation of blood pressure in hypertensive adolescents. From March 2018 to February 2019, 649 ABPMs from hypertensive adolescents between 13 and 17 years who were referred to wear an ABPM device in Beijing and Baoding were extracted. Seasonal change in ambulatory BP value, dipping status, and prevalence of different BP phenotypes were analyzed and compared. Mean age of participants was 14.9 ± 1.5 years and 65.8% of them were boys. Of the participants, 75.3% met the criteria of overweight or obesity. From summer to winter, average 24-hour, day-time, and night-time BP showed significant rise, which was 9.8/2.8, 9.8/3.0, and 10.9/3.4 mmHg, respectively. This seasonal effect on BP was not dependent on the obesity degree. In addition, higher prevalence of nondippers and risers existed in winter while white coat hypertension was more frequent in warmer seasons. Hypertensive adolescents showed evident seasonal change in their ABPM results, which was featured by elevated BP level and more frequent abnormal dipping patterns in winter. On the contrary, higher prevalence of white coat hypertension was found in warmer seasons. Physicians should take seasonal variation into consideration when managing adolescent hypertension.

White coat hypertension is another clinical characteristic of patients with inflammatory bowel disease: A cross-sectional study.

In this cross-sectional study, our aim was to analyze association of ambulatory blood pressure monitoring (ABPM) values with pulse wave velocity (PWV) in inflammatory bowel disease (IBD) patients as well as the prevalence and characteristics of white coat hypertension (WCH) in this group of patients with chronic inflammation and high prevalence of anxiety. We enrolled 120 consecutive IBD patients (77 Crohn´s disease; 43 ulcerative colitis) who were not treated with antihypertensive drugs without cardiovascular, cerebrovascular and renal morbidity. Office blood pressure, ABPM, and PWV were measured with Omrom M6, SpaceLab 90207, and Arteriograph, respectively. The prevalence of true normotension, sustained hypertension and WCH was analyzed in IBD patients. WCH was found in 27.5% patients. IBD-WCH patients had significantly lower prevalence of traditional risk factors than general WCH subjects. PWV and augmentation index (AIx) values were higher in WCH than in true normotensive patients. When adjusted for age and duration of IBD, only PWV was a positive predictor of WCH, and patients with higher PWV and longer disease duration had OR´s for WCH of 0.69 and 2.50, respectively. IBD patients had significantly higher prevalence of WCH and higher PWV values than healthy control patients. WCH is highly prevalent in IBD patients but IBD-WCH patients have lower frequency of traditional cardiovascular risk factors than general WCH population. Our results suggest that WCH could be considered as another clinical characteristic of IBD which is associated with increased arterial stiffness and those patients should be monitored more closely.

Prevalence and Demographic Profile of White-coat Hypertension in the Patients Visiting a Tertiary Care Center in Eastern Nepal

BACKGROUND: There is unequivocal evidence showing that at hospital environment BP levels are usually different from measures found at other settings. Therefore, ambulatory BP is expected to be more dependable, as well as allow the identification of a relevant subgroup of white-coat hypertension patient.&#x0D; METHODS: This was a single center descriptive cross-sectional study conducted to assess the prevalence of white-coat hypertension among 50 participants consisting of 31 males and 19 females referred for 24 hour Ambulatory BP monitoring in BPKIHS, Dharan, Nepal, between October 2021 to December 2021.&#x0D; RESULTS: The prevalence of white-coat hypertension was 19 (32%) among 50 participants, while 31(62%) of them had sustained hypertension. Prevalence of WCHTN and sustained hypertension in young age ≤35 years was 4 (21.1%) and 10 (32.3%) respectively, similarly middle age 36-54 years was 13(68.4%) and 16(51.6%) and elderly ≥55 years was 2(10.5%) and 5(16.1%) respectively. Most participants were of middle age group 36-54 years’ age. While of sex distribution pattern of WCHTN and sustained hypertension, male was 11(57.9%) and 20 (64.5%) respectively and female was 8(36.8%) and 15(48.4%) respectively. The association between the demographic variables age, sex and BMI and white-coat HTN was not statistically significant.&#x0D; CONCLUSION: The study showed that White-coat hypertension was more common in male patients and in middle age group 36-54 years, but was not statistically significant. Prevalence of white-coat hypertension was 19(38%). There was no significant association between white-coat hypertension and demographic variables.

Prevalence of White Coat Hypertension amongst Patients in the Kurdistan Region of Iraq-Erbil

Background: White coat hypertension (WCH) is a condition in which people exhibit an elevation in blood pressure (BP) in a clinical setting, although they do not show such elevation in other settings. This study aims to provide new insight into determining the prevalence of WCH amongst patients with or without any cardiovascular risk. Method: This is a cross-sectional study of convenience sampling study design where 300 patients were involved based on their consultation to a Tertiary Healthcare Unit between November 2021 to March 2022 in Erbil city. Patients were classified according to the ESC into different categories of BP patterns by comparing the first BP reading that was taken at clinic with their average AMBP readings which were taken at home. Results: A total of 300 patients were included in the study where 58% of the population was male and 42% of the population was female. Of the population, 16% had WCH, 12.3% had sustained HTN, 59.3% were considered to be normotensive (NT), and 12.3% among them were categorized as masked hypertension. From the total of 47 patients that were diagnosed with WCH, 55.3% were male and 44.7% were female patients. The overall average Systolic Blood Pressure in WCH was 125.79±15.30 mmHg, and in Hypertensives it was 147.70±17.15 mm Hg with a P-value of &lt;0.001. The Mean Arterial Pressure in WCH was 94.63±8.87 mmHg and in Hypertensives it was 112.16±13.62 mmHg with a P-value of &lt;0.001. The average Pulse Pressure in WCH was 75.27±9.42 mmHg, and in Hypertensives it was 76.35±9.11 mmHg with a P-value of 0.001. Conclusion: WHC is significantly prevalent in Erbil city; therefore AMBP monitoring should be performed for those with certain indications to limit the prescription of unnecessary long-term medications with possibly significant side effects to patients with WHC.

Prevalence and Related Factors of White Coat Hypertension and Masked Hypertension in Shunde District, Southern China.

Background: White coat hypertension (WCH) and masked hypertension (MH) can increase the risk of target organ damage. Home blood pressure monitoring is an important method for detecting WCH and MH. However, the prevalence and related factors of WCH and MH in China have been rarely reported. Objective: To explore the prevalence and related factors associated with white coat hypertension (WCH) and masked hypertension (MH) in Shunde District, Southern China. Methods: This study recruited subjects from the Physical Examination Center in Shunde Hospital, Southern Medical University. Office blood pressure and home blood pressure values were collected using the home blood pressure monitor with telemedicine device and office blood pressure monitor, and the prevalence of WCH and MH was calculated by the values. Multivariate logistic regression was used to explore the related factors for WCH and MH. Results: Four-hundred and sixty-one participants (61% male), with an average age of 49 years, were included. The prevalence of WCH and MH was 5.1 and 15.2%, respectively. Multivariate logistic regression analysis showed that smoking (OR = 4.71, 95% CI = 1.05–21.15) and family history of coronary heart disease (OR = 4.51, 95% CI = 1.08–18.93) were associated with higher odds of WCH. The associated factors for higher odds of MH were smoking (OR = 2.83, 95% CI = 1.11–7.23), family history of hypertension (OR = 2.17, 95% CI = 1.11–4.26) and family history of coronary heart disease (OR = 2.82, 95% CI = 1.07–7.45). Conclusion: WCH and MH are highly prevalent in the Physical Examination Center in Shunde Hospital, Southern Medical University. We found smoking and family history of coronary heart disease were related factors for WCH, and smoking, family history of hypertension and coronary heart disease were associated with the odds of MH. Home blood pressure monitoring with a telemedicine device should be recommended to identity abnormal BP phenotype.

COMPARISON OF OFFICE, HOME AND AMBULATORY BLOOD PRESSURE MEASUREMENT IN HYPERTENSIVE PARTICIPANTS IN THE POPULATION-BASED SWISS LONGITUDINAL COHORT STUDY (SWICOS)

Objective: The 2021 guideline of the ESH states that a reliable hypertension diagnosis should not be based on office BP measurement solely, but should be confirmed with the use of home BP measurement (HBPM) or 24 h ambulatory BP measurement (ABPM). The aim of our study was to compare BP measurements obtained in the office (OBPM), at home (HBPM) and ambulatory (ABPM) in individuals with elevated OBP participating in the Swiss Longitudinal Cohort Study (SWICOS). Design and method: Participants with OBP = &gt; 140/90mmHg were invited to assess their BP using HBPM and ABPM. The cut-off for hypertension was = &gt; 135/85 mmHg for HBPM and = &gt; 130/80 mmHg for ABPM. White-coat hypertension (WCH) was defined as normal HPBM or ABPM in the subgroup of participants who had OBP = &gt; 140/90mmHg. Undertreatment was defined as hypertension in HBPM or ABPM despite antihypertensive treatment. Results: Of 72 hypertensive participating subjects with office BP = &gt; 140/90mmHg and valid measurements of HBPM and ABPM, 39 were males (aged 62.8 ± 11.8y) and 33 were females (aged 57.4 ± 14.2y). Systolic BP measured in the office (151.7 ± 15.5 mmHg) was significantly higher than values measured using HPBM (130.0 ± 13.5 mmHg) (p &lt; 0.001) or during ABPM (131.8 ± 14.7 mmHg) (p &lt; 0.001). Diastolic BP was also highest in the office (89.3 ± 8.0 mmHg) and significantly different from HBPM (81.6 ± 6.6 mmHg) or ABPM (80.8 ± 11.2 mmHg) (both p &lt; 0.001). Hypertension was confirmed with HBPM in only 21 participants (29%), and with ABPM in 41 participants (57%). Participants who had hypertension according to ABPM but not to HBPM were significantly younger (p &lt; 0.001) and more frequently working (p &lt; 0.001). The prevalence of WCH was 44% using HBPM and 26% using ABPM. Undertreatment was found in 13 participants (18%) using HBPM and 21 (29%) using ABPM. Conclusions: This study found highest BP for OBPM; HBPM and ABPM were significantly lower. Hypertension prevalence was lower using HBPM than using ABPM in young working participants. Potentially, HBPM might lead to underdiagnosis and undertreatment. Nevertheless, the findings of this study support the ESH recommendations of complementing office BP using HBPM or ABPM given the high prevalence of WCH and undertreatment.

OBESITY MAY ACTUALLY BE A PRECIRRHOTIC CONDITION IN ADULTS

Background: There may be some significant relationships between the umbilical hernia, obesity, and cirrhosis during the process of metabolic syndrome in adults. Method: Consecutive patients with an umbilical hernia and/or a surgical repair history of the umbilical hernia were included. Results: There are 46 patients with the umbilical hernia with a mean age of 62.0 years, and 73.9% of them were female. Body mass index was higher in the hernia patients (33.6 versus 29.1 kg/m2, p= 0.000). Although the prevalence of hypertension (HT) was also higher in the hernia group (50.0% versus 27.3%, p&lt;0.01), mean values of triglycerides and low density lipoproteins and prevalence of white coat hypertension (WCH) were lower in them (p&lt;0.05 for all). Although prevalences of diabetes mellitus (DM) and coronary heart disease (CHD) were also higher in the hernia patients, the differences were nonsignificant, probably due to the small sample size of the hernia group. Conclusion: There may be some significant relationships between the umbilical hernia, obesity, cirrhosis, and other endpoints of the metabolic syndrome including HT, DM, and CHD, probably on the bases of prolonged inflammatory, atherosclerotic, and pressure effects of excessive fat tissue on abdominal wall muscles. The inverse relationships between obesity and hypertriglyceridemia and hyperbetalipoproteinemia may be explained by the hepatic fat accumulation, inflammation, and fibrosis induced relatively lost hepatic functions in obesity. Similarly, the inverse relationship between obesity and WCH may be explained by progression of WCH into overt HT in obesity. So obesity may actually be a precirrhotic condition in adults. Key words: Obesity, cirrhosis, metabolic syndrome, umbilical hernia, hepatosteatosis, atherosclerosis, end-organ insufficiency

Day and night blood pressure variability among older persons in South-Western Nigeria.

Hypertension is the largest contributor to the global burden of disease. Emerging risk factors for cardiovascular disease include blood pressure variability (BPV), but evidence on BPV is lacking among older Nigerians. We reported BPV in a cohort of older persons at the University College Hospital (UCH), Ibadan. We conducted a retrospective cohort study of respondents aged >50 years within the Ibadan Ambulatory Blood Pressure Registry at the UCH, Ibadan, Nigeria. Socio-demographic characteristics, lifestyle habits and anthropometric measurements were obtained. Among 639 respondents, 332 (52.0%) were female. The blood pressure (BP) variables were strongly associated with age. Compared with younger age groups, mean diastolic BP (DBP) was less at an older age, whereas mean pulse pressure was greater. During the wake-up and sleep periods, mean DBP and mean arterial BP were less with each increasing age category, whereas mean pulse pressure was larger with each increasing age category. BP dipping, systolic, diastolic and mean arterial BP decreased with age. Overall, timed BPV increased significantly with increasing age. The prevalence of white-coat hypertension was greater among older participants than younger participants. Most respondents in the 50-59 years' age group were non-dippers (55.8%), whereas 33.7% of older respondents were reverse-dippers. Older persons experienced a greater abnormal circadian blood variation and greater BPV than younger people. In Nigeria, follow-up data are needed to determine the prognostic significance of these data in this population.

White Coat Hypertension in Aircrew: Diagnosis and Clinical Implications

Introduction: When there is a difference of patient's blood pressure (BP) which is measured in a physician's office and patient’s home, it is said to have White Coat Hypertension (WCH). Prevalence of WCH is very much common among aircrew, because they need to face everyday preflight medical checkup. Objective: To find out the incidence of WCH among the aircrew of Bangladesh Air Force (BAF) as well as to ascertain the long-term clinical implications of WCH. Materials and Methods: This cross-sectional observational study was conducted among 150 aircrew, reported to Central Medical Board (CMB), Bangladesh Air Force (BAF) for periodical medical evaluation, during the period January 2014 to December 2018. Study subjects were selected purposively with age range 25-50 years; those who did not have any history of hypertension or received any anti-hypertensive medication but were detected elevated BP having clinical recording of BP ≥ 140/90 mm of Hg. Ambulatory blood pressure monitoring (ABPM) was performed on them for 24 hours in order to distinguish between those who were truly hypertensive and those who were suffering from WCH. To exclude secondary causes of hypertension as well as to assess for evidence of target organ damage (TOD), a thorough clinical and laboratory examination as well as regular follow-up were also performed. Results: White Coat Hypertension was observed in 26.7% of the aircrew. There was no evidence of target organ involvement, such as left ventricular dysfunction, left ventricular hypertrophy, hypertensive retinopathy or renal involvement. Conclusion: WCH is comparatively common among the aircrew. This highlights the importance of the requirement for regular follow up of all cases of WCH, over the normotensive subjects with a view to identify early organ involvement and therapeutic intervention are often initiated as and once needed. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 14-17

Abstract T1: Prognostic Value Of 24-hour Ambulatory Blood Pressure And Heart Rate Patterns In Diabetes: A 20-year Longitudinal Analysis Of The Chronic Diabetes Complications And All-cause Mortality In Pisa From 1999 Onwards (CHAMP1ON) Study Cohort

Background: Abnormal circadian blood pressure (BP) patterns and reduced heart rate variability (HRV) are established risk factors for cardiovascular events in diabetic patients. However, studies assessing all-cause mortality associated with altered BP patterns and HRV in diabetes are limited by follow-up periods of less than 10 years. Methods: We examined a cohort of 349 patients with type 2 diabetes ( n =284) or type 1 diabetes ( n =65) recruited in Pisa (Italy) from 1999 and followed-up for 21 years, all with available 24-hour ambulatory BP and HRV monitoring. Dipping, non-dipping and reverse dipping status were defined as a ≥10% decline, &lt;10% decline, and ≥0.1% increase in average night-time systolic BP (SBP) compared with average daytime SBP, respectively. Results: After 6,251 person-years of follow-up (median follow-up 21.0 [14.0-21.0] years, 183 [52%] women, age 57.1±11.9 y, BMI 29.4±5.9 kg/m 2 , HbA1c 8.6±2.1%), a total of 136 (39%) deaths occurred. Compared with dippers (n=166), non-dippers (n=144) and reverse dippers (n=39) showed progressively higher prevalence of cardiac autonomic neuropathy (11%, 16% and 31%, respectively), low HRV (45% vs 53% vs 62%), 24-hour hypertension (40%, 60% and 67%), isolated nocturnal hypertension (5%, 27% and 49%), postural hypotension (14%, 26% and 43%), and lower prevalence of white-coat hypertension (31%, 17% and 13%). Reverse dippers and non-dippers had progressively lower mean overall survival (OS) compared with dippers (16.1±5.3 years, 17.5±5.3 years and 18.6±4.6 years, respectively). Reverse dippers also showed an increased risk of all-cause mortality after adjustment for age, sex, BMI, office SBP, plasma glucose, and diabetes duration and type (HR 2.3 [1.4-3.8]). Patients with low HRV had reduced mean OS than those with high HRV (16.9±5.5 and 18.8±4.4, respectively) but similar adjusted risk (HR 1.3 [0.9-1.9]). No significant interactions emerged between BP patterns, HRV and diabetes type on OS. Conclusions: Non-dipping and reverse dipping BP patterns are associated with an increased prevalence of cardiac autonomic neuropathy and reduced survival probability in diabetic patients over a 21-year follow-up, with reverse dipping more than doubling the adjusted risk of all-cause mortality.