Masked Hypertension Research Articles

Masked hypertension is highly prevalent among patients with high-normal office blood pressure - based on the results of the Hungarian ABPM Registry

Abstract Background Current European guidelines recommend initiating antihypertensive treatment for patients with high-normal office blood pressure (HNOBP) if their cardiovascular (CV) risk is very high.1 Ambulatory blood pressure monitoring (ABPM) is a recommended tool to identify whitecoat- (WCH) and masked hypertension (MH), and both conditions can be present in patients with HNOBP. Purpose The purpose of our study was to assess the prevalence of white-coat and masked hypertension in patients with HNOBP, the proportion of very high CV risk, and to identify the predictors of WCH and MH. Methods We collected data from the Hungarian ABPM Registry, which is an ongoing, multicenter, open-label, observational study including 38720 adult patients. ABPMs were performed with validated Meditech ABPM-06 monitors. We analyzed the ABPM curves of 4389 HNOBP patients. In the diagnosis of hypertension, 24 hour-, daytime- and nighttime mean BP values were each considered separately. OBP measurements and ABPMs were performed by GPs, internists and cardiologists. 89 patients were excluded due to missing data. Results ABPM recordings confirmed MH in 67.4%(n=2899) of the cases, while WCH in 15.3%(n=659). In 17.3%(n=742) BP was in HN category both in the office and with ABPM (apparent high-normal blood pressure /appHNBP/). WCH patients (57.11±17.47) were older, than appHNBP (54.54±16.9), and MH patients (53.38±16.70)(p<0.001). WCH (19.4%, n=489) and appHNBP (19.4%, n=488) were more frequent among females, than in males (14.3%, n=254; 9.6%, n=170, respectively, p<0.001). However, MH was more prevalent in males compared to females (76.2%(n=1355) vs 61.2%(n=1544), respectively, p<0.001). Snoring, obesity and diabetes mellitus were more frequent in MH than in appHNBP and WHC patients (Snoring: 30.6%(n=887) vs. 25.7%(n=191) vs. 20.8%(n=137), p<0.001; Obesity: 22.9%(n=663) vs. 16.0%(n=119) vs. 13.4%(n=88), p<0.001;Diabetes mellitus: 12.1%(n=350) vs. 8.9%(n=66) vs. 9.9%(n=65), respectively, p=0.025). Independent predictors of WCH were age (OR=1.01[1.003;1.02]), female sex (OR=1.50[1.19;1.89]) and snoring (OR=0.76[0.59;0.97]). Independent predictors of MH were male sex (OR=1.69[1.43;2.00]), snoring (OR=1.27[1.06;1.53]) and obesity (OR=1.55[1.25;1.92]). 76% of all patients received antihypertensive treatment irrespective of the BP groups (WCH: 76.2%(n=502), appHNBP: 76.3%(n=566), MH: 76.5%(n=2217), p=NS). 11.7%(n=502) of all patients had very high CV risk and only 2.5%(n=25) did not receive antihypertensive treatment. Similar results were found among WCH, appHNBP and MH patients (very high CV risk: 13.8%(n=91) vs. 11.2%(n=83) vs.11.7%(n=328), p=NS; no treatment: 1.9%(n=3) vs. 1.7%(n=3) vs. 2.8%(n=19), p=NS). Conclusions In patients with HNOBP, MH is highly prevalent. MH might be suspected in young, obese, male patients with diabetes mellitus and snoring. WCH was more frequent in older females. Based on our data, the majority of patients with HNOBP and very high CV risk are treated.

Antihypertensive treatment of masked hypertension guided by ambulatory blood pressure monitoring: a double-blind, placebo-controlled trial

Abstract Background Masked hypertension, office normotension combined with out-of-office hypertension, is associated with target organ damage (TOD), but whether antihypertensive treatment guided by out-of-office blood pressure (BP) would reduce TOD is unproven. Purpose To assess TOD change on antihypertensive treatment guided by ambulatory BP monitoring. Methods We conducted a double-blind, placebo-controlled randomized trial at 15 Chinese hospitals. Enrolment started on February 14, 2017 and follow-up ended on October 31, 2021. Patients of either sex, aged 30-70 years, not on antihypertensive drugs were eligible, if at two screening visits 1-week apart office BP was <140/<90 mm Hg and the 24 hour, daytime or nighttime ambulatory BP was ≥130/≥80, ≥135/≥85, or ≥120/≥70 mm Hg, respectively. Patients had ≥1 sign of TOD: ECG left ventricular hypertrophy (LVH), brachial-ankle pulse wave velocity (baPWV) ≥1400 cm/s, or urinary albumin-to-creatinine ratio (ACR) ≥3.5 mg/mmol in women and ≥2.5 mg/mmol in men. Active antihypertensive treatment consisted of allisartan starting at 80 mg/day to be increased to 160 mg/day at month 2 and to be combined with amlodipine 2.5 mg/day at month 4, if the ambulatory BP remained uncontrolled. Matching placebos were used likewise in the control group. The primary endpoint included normalization of baPWV, ACR or LVH or ≥20% reduction in baPWV or ACR. Results Of 320 patients (43.1% women; mean age 54 years), 153 were randomized to active antihypertensive treatment and 167 to placebo. At baseline, office BP averaged 130/81 mm Hg and the 24 hour BP 136/84 mm Hg. The prevalence of elevated baPWV, ACR and LVH was 97.5%, 12.5%, and 7.8%. The 24-hour systolic/diastolic decreased by 9.0/5.6 mm Hg (95% CI: 7.5-10.5/4.8-6.5 mm Hg) on active treatment and by 1.4/1.0 mm Hg (-0.1-2.8/0.2-1.8 mm Hg) on placebo. Regression of TOD, the primary outcome, occurred more frequently in patients randomized to active treatment than in those assigned to placebo with 1 year rate of 45.8% (95% CI: 37.9-53.7%) and 25.8% (19.1-32.4%), respectively (P<.001 for between-group differences in BP and TOD). Per-protocol and subgroup analyses were confirmatory. Conclusions Masked hypertensive patients require antihypertensive treatment guided by out-of-office BP monitoring before subclinical TOD progresses to major cardiovascular complications.

Differential impact of clinic BP target on the prevalence and predictors of the masked uncontrolled hypertension and white-coat uncontrolled hypertension

Abstract Background Although intensive blood pressure (BP) control have been advocated, major clinical practices guidelines still recommend clinic BP (cBP) < 149/90 mmHg as the target for antihypertensive therapy. But, cBP targets could influence the prevalence and predictors of any hypertension phenotype. We investigated how different cBP targets impacted on the prevalence and predictors of masked uncontrolled hypertension (MUCH) and white-coat uncontrolled hypertension (WUCH) using the Korean Ambulatory Blood Pressure (KorABP) registry. Methods A multicenter prospective longitudinal cohort study was performed in outpatients with hypertension. Among 5,965 patients enrolled in the KorABP registry, 1,601 patients on antihypertensive medications with a valid ambulatory BP monitoring record were included in this study. Two different cBP targets, <130/80mmHg (intensive) and <140/90 mmHg (conventional) were investigated. Results Controlled ambulatory BP (aBP; <130/80 mmHg) was observed in 472 patients (29.5%). Controlled cBP was shown in 348 patients (21.7%) with the intensive cBP target and in 697 patients (43.5%) with the conventional cBP target. Controlled hypertension, WUCH, MUCH and uncontrolled hypertension were found in 294, 174, 54, and 1,075 patients with the intensive target and in 378, 94, 319 and 810 patients with the conventional target, respectively. Among the patients with controlled cBP, the prevalence of MUCH markedly decreased with the intensive target (15.5%), compared to the conventional target (45.8%). In contrast, among the patients with uncontrolled cBP, the prevalence of WUCH had only 3.8% increase with the intensive target (10.4%), compared to the conventional target (14.2%) (Figure 1). With the conventional target, 75.9% of patients with MUCH had cBP between 130/80 mmHg and 139/89 mmHg. The concordance between the controlled aBP and controlled cBP was higher with the intensive target than with the conventional target (Cohen’s κ 0.62 [0.58-0.67] vs. 0.46 [0.41-0.50]). The logistic models for MUCH included the left ventricular mass index and underuse of antihypertensive drugs (<2 types of drugs) as the common predictors of the both targets. With the conventional target, clinic systolic BP and diastolic BP were the strongest predictors of MUCH, but the cBP was not a predictor of MUCH with the intensive target. The logistic models for WUCH included beta-blocker use, increased heart rate and lower waist circumference and clinic systolic BP as the common predictors of WUCH with the both target. The logistic model for MUCH performed better with the conventional target, whereas the logistic model for WUCH performed better with the intensive target (Figure 2). Conclusion The use of the intensive cBP target (<130/80 mmHg) could reduce the prevalence of MUCH with minimal increase in the prevalence of WUCH and would provide the better assessment for the BP control status than the use of the conventional cBP target (<140/90 mmHg).Figure 1Figure 2

Cardiovascular events risk in office-masked nocturnal hypertension defined by home blood pressure monitoring: the J-HOP nocturnal blood pressure study

Abstract Background Elevated nocturnal home blood pressure (BP) has been reported to be associated with increased risk for cardiovascular disease (CVD). Masked hypertension defined by home BP monitoring is also a strong risk factor for adverse CVD outcomes. However, no study has investigated the association between office-masked nocturnal hypertension defined by home BP monitoring and CVD events risk. Purpose This study aimed to examine the association between office-masked nocturnal hypertension defined by home BP monitoring and CVD events risk in a clinical practice-based population. Methods This was a prospective observational study including Japanese participants with CVD or high risk of CVD. Three office BPs were taken on two different occasions. Nocturnal home BP was measured three times per night for two weeks. The association between office-masked nocturnal hypertension and incident total CVD events (including fatal and non-fatal stroke and coronary heart disease) was examined using Cox regression. Results 2,545 participants were followed for the mean of 7.1 years (18,116 person-years), during which 152 (6.0%) CVD events occurred. Mean age (standard deviation) was 63.3 (10.3) years; 49.0% were male; 82.6% took antihypertensive medications. The proportions of participants with normotension (office BP <140/90 mmHg and nocturnal home BP <120/70 mmHg), white-coat hypertension (office BP ≥140/90 mmHg and nocturnal home BP <120/70 mmHg), office-masked nocturnal hypertension (office BP <140/90 mmHg and nocturnal home BP ≥120/70 mmHg), and sustained hypertension (office BP ≥140/90 mmHg and nocturnal home BP ≥120/70 mmHg) were 25.3%, 14.4%, 23.2%, and 37.1%, respectively. The office-masked nocturnal hypertensive group and sustained hypertensive group had higher incidence rates of total CVD events compared with the normotensive group. Relative to normotension, those with both office-masked nocturnal hypertension (adjusted hazard ratio [aHR] 1.72, 95% confidence interval [CI] 1.01–2.92) and sustained hypertension (aHR 1.75, 95%CI 1.03–2.96) had similarly increased CVD risk, even after adjustment for daytime home BP values. Conclusions Screening for office-masked nocturnal hypertension with home BP monitoring identifies a potentially important group of patients with increased risk for incident CVD events for whom additional preventative measures may be appropriate.

Prevalence and prediction of masked uncontrolled hypertension in patients recently hospitalised for an acute coronary syndrome

Abstract Background Masked uncontrolled hypertension (MUCH) is defined as normal office blood pressure (BP) but elevated out-of-office BP in patients on antihypertensive treatment. MUCH is associated with similar cardiovascular risk as sustained hypertension and is clinically challenging since this often remains undetected without out-of-office BP measurements. Purpose To study the prevalence of MUCH following an acute coronary syndrome and to utilise machine learning methods to develop prediction models for identifying MUCH. Methods Ambulatory 24-h BP measurement (ABPM) was performed in 100 patients attending the cardiology outpatient clinic at a Swedish university hospital following an acute coronary syndrome, as part of a study which screened for co-morbidities. From the SWEDEHEART registry, 106 variables during the hospital care period and subsequent follow-up visit (after 6-10 weeks) were pre-processed including filtering on 5 or more missing values and zero or near-zero variance. Variable importance for the prediction of MUCH (office BP < 140/90 mm Hg at ABPM start but mean 24-h BP ≥ 130/80 mm Hg) was assessed using the Boruta and least absolute shrinkage and selection operator (LASSO) machine learning algorithms. Subsequently, logistic regression, LASSO and random forest models using different variable subsets were evaluated by receiver operating characteristic area under the curve (AUC) in repeated cross-validation. Results Age was 62.0±8.4 years, 74% male, 54% had NSTEMI and 46% STEMI. The follow-up visit and ABPM were performed at median 7 and 11 weeks, respectively, after hospital discharge. Among 90 patients with complete data and ABPM recordings, 31 had mean 24-h BP above target levels, of which 18 were identified with MUCH. Patients with MUCH had lower eGFR (68±11 vs 76±12 ml/min/1.73m², P=0.009), and more often a history of hypertension (89 vs 53%, P=0.005) and diabetes mellitus (44 vs 11%, P=0.003). In total, 65 variables where eligible for machine learning after filtering. Boruta and LASSO identified pulse pressure at the follow-up visit, serum creatinine, diabetes mellitus and history of hypertension as important predictors. Random forest, logistic regression and LASSO showed mean AUC 0.826, 0.822, and 822, respectively, in cross validation using these predictors. Conclusions In this small trial, one in five had MUCH at follow-up after an acute coronary syndrome, which highlights the importance of out-of-office BP measurements. The easily accessible measures of pulse pressure at the follow-up visit, serum creatinine, diabetes mellitus and history of hypertension were identified as important predictors of MUCH. A simple prediction model may be used as a clinical decision support tool after appropriate external validation.

Stress-induced arterial hypertension: search for predictors

Background. Despite the existence of a clear cause-and-effect relationship between job strain and hypertension, there are still no clear criteria for defining stress-induced arterial hypertension (SIAH). Objective. Search for SIAH criteria, in particular predictors of hypertension in the workplace. Materials and methods. The study included volunteers experiencing stress in the workplace and not having hypertension. Before the start of the working day and at the end of the working day, the subject was surveyed, given questionnaires (Ch. D. Spielberg scale, Montgomery-Asberg MADRS scale, A. M. Vein scale, hospital anxiety and depression scale HADS), blood pressure and resting heart rate were measured, fasting blood was taken to determine the values of ACTH, TSH, T4, insulin, cortisol. All patients underwent ABPM on a working day and a day off. Results. According to ABPM (n=52), no signs of masked hypertension were detected, however, significant differences between workdays and weekends in the levels of maximum SBP and DBP during the daytime were noteworthy. In the group with maximum SBP>140 mm Hg during the daytime (SIAH, n = 34), on a workday there was an increase in the time index for SBP>30% (24 hours and day), characteristic of hypertension, and for DBP (24 hours and day), characteristic of borderline (possible) hypertension, the average DBP values during the day and at night were at the upper limit of the norm, which was significantly different from the Normotonic group (n = 19). On a weekday, the SIAH group also had significantly increased SBP (24 hours, day) and DBP (24 hours, day and night) indexes versus Normotonic. For all other indicators except ABPM, the groups were comparable. Conclusions. Taking into account the increase in the time index for SBP and DBP, it can be assumed that, against the background of stressful situations at the workplace, the subjects had short frequent increases in blood pressure, which have not yet led to a significant violation of self-regulation of blood pressure and the development of hypertension. An increase in the maximum values of systolic and/or diastolic blood pressure against the background of an increased time index on a working day are possible predictors of SIAH, in particular hypertension at the workplace.

Changes in 24-hour blood pressure profile after 12 weeks of dapagliflozin treatment in patients with diabetic kidney disease: an Italian multicenter prospective study

Abstract Background and hypothesis Sodium-glucose cotransporter-2 inhibitors (SGLT2i) lower ambulatory blood pressure (ABP) in patients with Type 2 Diabetes Mellitus; whether the same holds true in diabetic kidney disease (DKD) is unknown. This information is critical to the knowledge of mechanisms of nephroprotection and safety of this therapy. Methods This multicenter prospective study evaluates the changes in ABP after 12 weeks of dapagliflozin 10 mg/day in a cohort of patients with type 2 DKD and GFR >25 ml/min/1.73 m2. Primary endpoint was the change of nighttime systolic blood pressure (SBP). Changes of daytime SBP, prevalence of normal dipping (day/night SBP ratio<0.9) and changes in ABP patterns, that is, sustained uncontrolled hypertension (SUCH), white coat uncontrolled hypertension (WUCH), masked uncontrolled hypertension (MUCH) and controlled hypertension (CH) were secondary endpoints. Results 83/96 patients completed the study (age 68.7±8.9 years, 73.5% males, GFR 49±17 ml/min/1.73m2, median albuminuria: 0.18 [IQR 0.10-0.38] g/24h). After 12 weeks of dapagliflozin, nighttime SBP declined by -3.0 mmHg (95%CI -5.2/-0.8 mmHg; P=0.010) with an improvement of nighttime SBP goal (<110 mmHg) from 18.0% to 27.0% (P<0.001). Similarly, the prevalence of normal dipping increased (from 31.3% to 50.6 %, P=0.005). A decrease in daytime (-2.4 mmHg; P=0.046) and office (-7.9 mmHg; P=0.009) SBP was also found. The decline of ambulatory and office SBP was associated with increased prevalence of CH (from 6.0% to 18.0%) and significant improvement of SH, WCH and MH (P=0.009). Albuminuria decreased (P<0.001) whereas eGFR did not change (p=0.297). Urinary tract infection (4.2%) and acute kidney injury (3.6%) were the main causes of drop-out. Only one patient showed a drop of nighttime SBP below 90 mmHg. Conclusions Dapagliflozin is associated with improvement in circadian BP rhythm with no major safety signal related to excessive BP decrease.

Ambulatory blood pressure monitoring in Egyptian children with nephrotic syndrome: single center experience

BackgroundHypertension (HTN), especially masked hypertension, is one of the cardiovascular consequences of nephrotic syndrome. Masked hypertension cannot be identified during routine follow-up visits and adversely effects the patients’ cardiac function. The purpose of this study was to use ambulatory blood pressure monitoring (ABPM) to evaluate the blood pressure status of children with nephrotic syndrome.MethodsNinety children with nephrotic syndrome (NS) participated in this cross-sectional study, which was carried out at Cairo University Children Hospital’s nephrology clinic (CUCH). A sphygmomanometer was used in the clinic to measure blood pressure, and a Meditech monitor was used for 24-hour ambulatory blood pressure monitoring (ABPM). Interventricular septum (IVS) was measured, and heart functions were evaluated, using echocardiography.ResultsTwo groups comprised the included patients: Group1 (n = 70): HTN group included masked and ambulatory hypertension, and Group 2 (n = 20): non-HTN group included normal blood pressure, white coat HTN and well controlled HTN, 35% of the studied cohort (n = 32/90) had masked HTN.The serum urea was significantly higher in HTN group than non-HTN group with p-value: 0.047, while the serum albumin was significantly lower in HTN group than non-HTN group with p-value: 0.017. The cut-off point of 9.9, the sensitivity and specificity of serum urea to predict the occurrence of hypertension in NS patients was 92.9% and 35% respectively, with p-value : 0.024 and 95% CI (0.534–0.798). The z score of IVS is significantly higher in group 1 (2.5 ± 1.2) when compared to group 2 (1.7 ± 2.1) with p-value: 0.025 and Among group 1, it was noticed that 74% (n = 52/70) of them were systolic non-dipper, also it was observed that the mean serum potassium and cholesterol were significantly higher among systolic non-dipper when compared with systolic dipper patients with p-values: 0.045 and 0.005 respectively.ConclusionChildren with nephrotic syndrome are particularly vulnerable to experience ambulatory hypertension and masked hypertension, which may adversely impact their cardiac condition because they are not detectable by standard blood pressure readings at the clinic.

Prevalence of masked and white-coat hypertension among individuals with diabetes: insights from web-based home blood pressure monitoring in the Brazilian population.

The association between diabetes mellitus (DM) and masked hypertension (MH) in ambulatory blood pressure (BP) monitoring is established, but its relationship with home BP monitoring (HBPM) remains uncertain. This web-based database study compared BP phenotypes in individuals using (n = 51,194; 6.05% with DM) and not using (n = 55,320; 0.63% with DM) antihypertensive medications (AH) undergoing HBPM. Multivariable logistic regression analysis revealed similar MH and white-coat hypertension (WCH) prevalence in individuals with or without DM, irrespective of AH use. However, among AH non-users, DM was associated with a higher likelihood of normotension (OR 1.35, 95%CI 1.09-1.66; p = 0.006) and a lower likelihood of sustained hypertension (OR 0.77, 95%CI 0.60-0.99; p = 0.039) compared to individuals without DM. These findings suggest that while DM does not significantly impact MH and WCH in HBPM, it may influence normotension and sustained hypertension rates in AH non-users. Likelihood of diabetes mellitus according to blood pressure phenotypes. AH - antihypertensive medications; CH - controlled hypertension; MH - masked hypertension; MUCH - masked uncontrolled hypertension; NT - normotension; SH - sustained hypertension; SUCH - sustained uncontrolled hypertension; WCH - white-coat hypertension; WUCH - white-coat uncontrolled hypertension.

Predictors of the development of abnormal patterns of circadian blood pressure rhythm in patients with hypertension after a new coronavirus infection

Objective. To determine the predictors of the development of abnormal patterns of circadian blood pressure (BP) rhythm in patients with arterial hypertension (AH) after a new coronavirus infection (NСVI). Materials and methods. The study is a comparative clinical research of the same patients with hypertension before and after NCVI with retrospective evaluation of the data. Within 2 years from 842 patients with cardiovascular risk factors, according to the inclusion and non-inclusion criteria 70 patients with target levels of office BP, home monitoring and 24-hour blood pressure monitoring (ABPM) on the background of a continuous antihypertensive therapy were included in the study. Abnormal patterns of circadian BP were recorded after NCVI during ABPM in all of them. All patients with hypertension underwent a complete examination before and after NCVI. Results. After NCVI in patients with AH who had achieved the target ranges of office BP before its development, at home measurement and ABPM against the background of continuous antihypertensive therapy with high adherence to treatment, in more than 50 % of patients BP readings were not in the target values, in more than 50 % of the examined patients, BP variability was higher than the permissible values, in 73 % of patients the average daily BP was above 53 mm Hg. Abnormal patterns of circadian BP rhythm in patients with hypertension after NCVI were detected in 61.5 %: "Non-dipper" in 28.6 %; "Night-dipper" – in 21.9 %, masked nocturnal hypertension – in 17.1 %. Conclusion. The indicative significance of the development of abnormal patterns of circadian BP rhythm in patients with hypertension after NCVI was demonstrated by 3 qualitative indicators: glomerular filtration rate with cystatin C 60 ml/min/1.73 m2, cardio-ankle vascular index (CAVI) ≥ 9, and a high frequency of AGT gene polymorphism – T/T genotype (in 54.3 % of patients).

HYPERTENSION IN THE ELDERLY: CHALLENGES IN MANAGEMENT AND TREATMENT

Hypertension is a prevalent and significant health issue among the elderly, contributing to increased risks of cardiovascular diseases, stroke, and kidney failure. Managing hypertension in older adults poses unique challenges due to age-related physiological changes, comorbidities, and polypharmacy. This review explores the complex pathophysiology of hypertension in the elderly, including age-related changes in vascular function and the impact of comorbid conditions. It examines the difficulties in diagnosing hypertension, such as variability in blood pressure readings, white coat syndrome, and masked hypertension, highlighting the need for accurate monitoring through home and ambulatory techniques. The review discusses current management strategies, emphasizing the importance of setting appropriate treatment goals, implementing lifestyle modifications, and utilizing pharmacological treatments, including new antihypertensive drugs and combination therapies. It also addresses challenges such as adverse drug reactions, medication adherence, and the management of polypharmacy. Recent advances, including innovations in drug delivery systems and digital health technologies, offer promising solutions for improving hypertension management. Future research directions include exploring precision medicine, understanding the role of the gut microbiome, and addressing health disparities. Clinicians are advised to adopt personalized treatment approaches, integrate technological tools, and address socioeconomic barriers to optimize hypertension management in the elderly. This review underscores the need for ongoing research and tailored strategies to improve outcomes and quality of life for older patients with hypertension.

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.

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 (<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 <120mmHg and >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 < 120mmHg. 27/52(52%) had OSBP between 120 and 149 mmHg. 22/52(42%) had an OSBP >150mmHg. We examined the medication profile of those patients who had an OSBP <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 >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.

White coat hypertension in acute retinal vein occlusion

PurposeTo investigate the association between white-coat hypertension (WCH) and acute retinal vein occlusion (RVO).MethodsIn this retrospective case-control study, patients aged 40 years or older diagnosed with acute-phase RVO were included. Patients with other pathologies served as non-RVO controls. Blood pressure (BP) was measured in the office during their initial visit, and information about home BP and hypertension (HTN) medication was obtained through interviews. After 1:2 age and sex-matching between the RVO and non-RVO groups, the proportions of HTN cases were compared. A similar comparison was made in subgroups with or without HTN medication.ResultsFifty-one patients with RVO and 102 with non-RVO were included in the analysis. For the entire cohort, the RVO group exhibited a significantly greater proportion of WCH and sustained HTN compared to the non-RVO group. In the subgroup without HTN treatment, the proportion of WCH or sustained HTN was still significantly higher in the RVO group. However, in the subgroup receiving HTN treatment, the proportion of WCH or sustained HTN was higher in the RVO group than in the non-RVO group, though not statistically significant.ConclusionThis case-control study suggests that WCH may be associated with RVO, particularly in patients without HTN treatment. Given that interventions for WCH have not been standardized, a more detailed and prospective study is warranted to elucidate the risk of WCH for RVO and other retinal vascular diseases.

Prevalence and Characteristics of Isolated Nighttime Masked Uncontrolled Hypertension in Treated Patients.

Background and Objectives: We evaluated the prevalence and characteristics of isolated nighttime masked uncontrolled hypertension (IN-MUCH) in treated patients. Materials and Methods: Participants aged 20 years or older who were on antihypertensive medication underwent three-day office blood pressure (BP) and 24 h ambulatory BP measurements. Hypertension phenotypes were classified as controlled hypertension (CH), isolated daytime masked uncontrolled hypertension (ID-MUCH), IN-MUCH, and daytime and nighttime masked uncontrolled hypertension (DN-MUCH). Results: Among 701 participants, 544 had valid BP data and controlled office BP (<140/90 mmHg). The prevalence of IN-MUCH was 34.9%, with a higher prevalence of men and drinkers than in those with CH. Patients with IN-MUCH had higher office systolic BP (SBP) and diastolic BP (DBP) than those with CH. The prevalence of IN-MUCH was 37.6%, 38.5%, and 27.9% in patients with optimal, normal, and high-normal office BP levels, respectively. Among IN-MUCH patients, 51.6% exhibited isolated uncontrolled DBP and 41.1% uncontrolled SBP and DBP. Younger age (p = 0.043), male sex (p = 0.033), and alcohol consumption (p = 0.011) were more prevalent in patients with isolated uncontrolled DBP than in those with uncontrolled SBP and DBP. Age and alcohol consumption were positively associated, whereas high-normal office BP exhibited a negative association with IN-MUCH. Conclusions: The IN-MUCH was significantly more prevalent in patients with normal or optimal office BP, posing treatment challenges. Further investigation is needed to determine whether differentiation between isolated uncontrolled DBP and combined uncontrolled SBP and DBP is necessary for prognostic assessment of IN-MUCH.

Hypertension in children and adolescents: perspectives in Japan.

Hypertension in children and adolescents is associated with increased risk of hypertension and cardiovascular disease (CVD) in adulthood. Therefore, preventing hypertension among children and adolescents is an important public health objective worldwide. Although the importance of hypertension in children and adolescents has increasingly been recognized, the field of research is relatively new and evidence for etiologies, prevention and treatment is sparse. This review mainly summarizes the content regarding hypertension in children and adolescents published in Hypertension Research in 2023/24. Highlights include the following: The prevalence of hypertension was higher in female than male Japanese junior high school students (13.7% vs. 4.7%), but there was no significant gender difference among Japanese senior high school students (7.4% vs. 5.4%). Hematological parameters, including red blood cell counts, hemoglobin counts, hematocrit and iron levels, were positively associated with blood pressure (BP) levels in healthy children and adolescents. Higher-risk longitudinal BP trajectories in early life were associated with increased risk of target organ damage (TOD) and higher combined TOD load in midlife. BP phenotypes (e.g., masked hypertension, white-coat hypertension) assessed using office and 24-h ambulatory BP monitoring were not highly reproducible in children. The salt check sheet was a useful tool for evaluating the approximate dietary salt intake in Japanese children and adolescents. It is recommended that healthcare providers screen for hypertension in children and adolescents and recognize the importance of early intervention for those with elevated BP levels. Beginning in childhood, continuous education on hypertension and proper dietary salt intake are key to reducing the risk of hypertension and decreasing the burden of CVD in adulthood.

Resistant Hypertension and Mortality: An Observational Cohort Study.

Resistant hypertension is characterized by elevated blood pressure (BP) despite using 3 antihypertensive agents. Ambulatory BP monitoring (ABPM) detects the presence of white-coat resistant hypertension (24-hour BP <130/80 mm Hg). The aim of the study was to evaluate risks of death in resistant hypertension compared with controlled hypertension, as well as in ABPM-confirmed (24-hour BP ≥130 or 80 mm Hg), versus white-coat resistant hypertension. We selected 8146 patients with controlled hypertension (office BP <140/90 mm Hg while being treated with ≤3 antihypertensive drugs) and 8577 with resistant hypertension (BP ≥140 or ≥90 mm Hg while being treated with ≥3 drugs). All-cause and cardiovascular mortalities (median follow-up, 9.7 years) were compared between groups, as well as between patients with white-coat (3289) and ABPM-confirmed (5288) resistant hypertension. Hazard ratios (HRs) from Cox models after adjustment for clinical confounders were used for comparisons. Compared with controlled hypertension, resistant hypertension was associated with an increased risk in all-cause (HR, 1.21 [95% CI, 1.12-1.30]) and cardiovascular mortalities (HR, 1.33 [95% CI, 1.17-1.51]) in confounder-adjusted models. Compared with white-coat, ABPM-confirmed resistant hypertension was associated with an increased risk of all-cause (HR, 1.45 [95% CI, 1.32-1.60]) and cardiovascular (HR, 1.68 [95% CI, 1.43-1.98]) mortalities. When ABPM-confirmed and white-coat resistant hypertension were separately compared with controlled hypertension, only the former was associated with an increased risk of death and cardiovascular death (HR, 1.36 [95% CI, 1.26-1.48] and 1.56 [95% CI, 1.36-1.79]), respectively. ABPM-confirmed resistant hypertension is associated with an increased risk of death and cardiovascular death with respect to both controlled hypertension and white-coat resistant hypertension.

Serum neutrophil gelatinase-associated lipocalin and cystatin C is associated with blood pressure in ex-preterm children and adolescents.

As preterm birth is a risk factor for hypertension (HTN), biomarkers for early prediction of HTN in childhood is an emerging need. The aims of the study were to evaluate serum biomarkers in ex-preterm children and examine for associations with office peripheral and central SBP (cSBP), ambulatory BP parameters and pulse wave velocity (PWV). This case-control study included children and adolescents born prematurely (ex-preterms) and at full term (controls). All participants underwent office and ambulatory BP monitoring, assessment of cSBP, PWV and serum biomarkers at the same visit. Neutrophil gelatinase-associated lipocalin (NGAL), matrix metalloproteinase-2, metalloproteinase-9 (MMP-2, MMP-9) and Cystatin C (CysC) were measured using ELISA. The study population included 52 ex-preterm individuals and 26 controls. Mean age was 10.7 ± 3.6 years. NGAL, MMP-2, MMP-9, and CysC levels were similar between the ex-preterm and the control group. In the ex-preterm group, NGAL is associated with office SBP z score (β = 1.007, 95% CI 1.001-0.014, P = 0.049), CysC with office DBP z score (β = 1.003, 95% CI 1.001-0.005, P = 0.018) and cSBP z score (β = 1.003, 95% CI 1.001-0.005, P = 0.006) independently of age, sex and BMI z score. Among ex-preterm children and adolescents 17% had ambulatory HTN and 31% had white-coat HTN. NGAL levels were higher in ex-preterm children with WCH compared with children with normal BP [57.9 (IQR 50.8) versus 34.6 (IQR 46.2)], P = 0.018]. WCH is common in ex-preterm children and adolescents and is associated with higher NGAL levels and CysC presents positive association with cSBP. The findings in this study provides preliminary evidence that NGAL and CysC may have a role in predicting the risk of developing hypertension later in life. Further studies are warranted.

Masked uncontrolled hypertension among elderly black sub-saharan africans compared to younger adults: a cross-sectional in-hospital study

BackgroundAlthough aging and being of African descent are well-known risk factors for masked uncontrolled hypertension (MUCH), data on MUCH among elderly black sub-Saharan Africans (BSSA) are limited. Furthermore, it is unclear whether the determinants of MUCH in younger individuals differ from those in the elderly.ObjectiveThis study aimed to determine the prevalence and risk factors associated with MUCH in both elderly and younger BSSA individuals.MethodsIn this study, 168 patients with treated hypertension were assessed for medical history, clinical examination, fundoscopy, echocardiography, and laboratory data. All patients underwent ambulatory blood pressure (BP) monitoring for 24 h. MUCH was diagnosed if the average 24-h mean BP ≥ 130/80 mmHg, the daytime mean BP ≥ 135/85 mmHg, and/or the nighttime mean BP ≥ 120/70 mmHg, despite controlled clinic BP (≤ 140/90 mmHg). Logistic regression analysis was performed to assess independent factors associated with MUCH, including elderly and younger adults separately. P-values < 0.05 were used to indicate statistical significance.ResultsOf the 168 patients aged 53.6 ± 11.6 years, 92 (54.8%) were men, with a sex ratio of 1.2, and, 66 (39%) were aged ≥ 60 years. The proportion of patients with MUCH (27.4% for all patients) was significantly higher (p = 0.002) among elderly patients than among younger patients (45.5% vs. 15.7%). Diabetes mellitus (adjusted odds ratio [aOR], 2.44; 95% confidence interval [CI], 1.27–4.46; p = 0.043), anemia (aOR, 3.18; 95% CI, 1.07–5.81; p = 0.043), hypertensive retinopathy (aOR, 4.50; 95% CI, 1.57–5.4; p = 0.043), and left ventricular hypertrophy (aOR, 4.48; 95% CI, 2.26–8.35; p = 0.043) were independently associated with MUCH in the elderly. In younger individuals, male gender (aOR, 2.16; 95% CI, (1.33–4.80); p = 0.029), obesity (aOR, 3.02; 95% CI, (1.26–5.32); p = 0.001), and left ventricular hypertrophy (LVH) (aOR, 3.08; 95% CI, (2.14–6.24); p = 0.019) were independently associated with MUCH were independently associated with MUCH.ConclusionMUCH is more prevalent among elderly than among younger BSSA individuals. Determinants of MUCH vary by age. MUCH prevention and management strategies should be age-specific.

Abstract MP12: Reproducibility of White Coat Hypertension and White Coat Uncontrolled Hypertension Among U.S. Adults

White coat hypertension (WCH) and white coat uncontrolled hypertension (WUCH) are phenomenon characterized by uncontrolled office blood pressures (BP) in the presence of normal out-of-office BPs among untreated and treated individuals, respectively. Although prior studies have investigated the reproducibility of WCH and WUCH, they were mainly limited to non-U.S. adults. We assessed white coat status in 272 (75% treated) adults with elevated office BP(≥130/80 mmHg) who had home BP (HBP) measurements for three consecutive months without initiation or intensification of antihypertensive medications during the three-month time interval of interest. HBP measurements were included only when number of readings were ≥12/month. WCH and WUCH was defined as HBP≤130/80 mmHg in untreated and treated adults, respectfully. The reproducibility was assessed using the Kappa coefficient (K) with 95% confidence intervals (CI). Mean age was 76±5 years (57% women, 12% Black adults). WCH was found in 39 of the 68 untreated adults with elevated office BP. WCH adults had an average home BP of 118/72±8/5 mmHg after the initial month of HBP monitoring (HBPM). As shown in Figure 1 , 87% and 85% had WCH status confirmed on repeat assessment after an additional one- and two-month interval of HBPM (K=0.54 and 0.48, respectfully). WUCH was found in 92 of the 204 treated adults with elevated office BP and had an average home BP of 120/71±5/5 mmHg. Of those, 86% and 84% had WUCH confirmed on repeat assessment after an additional one- and two-month interval of HBPM (K=0.65 and 0.52, respectfully). In conclusion, WCH and WUCH phenotypes when assessed by home blood pressure monitoring exhibited fair-to-moderate reproducibility among U.S. adults.