Document Detail

Prevalence, predictive factor, and clinical significance of white-coat hypertension and masked hypertension in Korean hypertensive patients.
Jump to Full Text
MedLine Citation:
PMID:  18309684     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The prevalence and clinical significance of white-coat hypertension (WCHT) and masked hypertension (MHT) are unknown in Koreans. Here we measure the frequency of WCHT and MHT in hypertensive subjects and identify the epidemiologic and/or clinical factors that predict it in Korean subjects. METHODS: This study is a retrospective analysis of a random sample from February 2004 to October 2005. All patients had measurements of blood pressure (BP) in the clinic and 24-hour ambulatory blood pressure monitoring (ABPM). Subjects were classified into four groups on the basis of daytime ambulatory BP and clinic BP level: 1) Normotension (NT), 2) MHT, 3) WCHT, and 4) sustained hypertension (SHT). RESULTS: For all 967 patients, the mean clinic BP was 157.7 +/- 22.0/ 95.3 +/- 13.1 mmHg, and the mean daytime ambulatory BP was 136.4 +/- 15.0/ 86.2 +/- 10.7 mmHg. The NT, MHT, WCHT, and SHT groups consisted of 51 (5.3%), 55 (5.7%), 273 (28.2%), and 588 (60.8%) subjects, respectively. The left ventricular mass index was significantly higher in SHT than in the other groups, and was positively correlated with BP, especially ABPM. Compared with NT, the factors associated with MHT were younger age, male gender, higher BMI, clinic BP > or = 130 mmHg, and alcohol consumption. Compared with SHT, the factors associated with WCHT were female gender, lower BMI, and clinic BP < 150 mmHg. CONCLUSIONS: WCHT and MHT were prevalent in the hypertensive population. ABPM was more predictive of target organ damage than clinic BP, and could be useful in identifying subjects at risk for WCHT and MHT.
Authors:
Eui-Seock Hwang; Kee-Joon Choi; Duk-Hyun Kang; Gi-Byoung Nam; Jae-Sik Jang; Young-Hoon Jeong; Chang-Hoon Lee; Ji-Young Lee; Hyun-Koo Park; Chong-Hun Park
Related Documents :
19020424 - Validation of a&d ua-85x device for blood pressure measurement.
16330894 - Blood pressure circadian rhythm and endothelial function in heavy smokers: acute effect...
16364834 - Prolonged melatonin administration decreases nocturnal blood pressure in women.
12172314 - Nurse-recorded and ambulatory blood pressure predicts treatment-induced reduction of le...
10597094 - Subarachnoid hemorrhage following permissive hypercapnia in a patient with severe acute...
7645124 - Vascular resistance quantification in high flow resistance areas using the doppler method.
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Korean journal of internal medicine     Volume:  22     ISSN:  1226-3303     ISO Abbreviation:  Korean J. Intern. Med.     Publication Date:  2007 Dec 
Date Detail:
Created Date:  2008-03-03     Completed Date:  2008-05-07     Revised Date:  2010-09-22    
Medline Journal Info:
Nlm Unique ID:  8712418     Medline TA:  Korean J Intern Med     Country:  Korea (South)    
Other Details:
Languages:  eng     Pagination:  256-62     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Blood Pressure Monitoring, Ambulatory
Female
Health Status Indicators
Heart Ventricles / physiopathology*,  ultrasonography
Humans
Hypertension / epidemiology*,  ultrasonography
Hypertrophy, Left Ventricular / physiopathology*,  ultrasonography
Korea / epidemiology
Male
Middle Aged
Prevalence
Retrospective Studies
Risk Factors
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Full Text
Journal Information
Journal ID (nlm-ta): Korean J Intern Med
Journal ID (publisher-id): KJIM
ISSN: 1226-3303
ISSN: 2005-6648
Publisher: The Korean Association of Internal Medicine
Article Information
Download PDF
Copyright © 2007 The Korean Association of Internal Medicine
Received Day: 25 Month: 3 Year: 2007
Accepted Day: 07 Month: 6 Year: 2007
Print publication date: Month: 12 Year: 2007
Electronic publication date: Day: 20 Month: 12 Year: 2007
Volume: 22 Issue: 4
First Page: 256 Last Page: 262
ID: 2687672
DOI: 10.3904/kjim.2007.22.4.256
PubMed Id: 18309684

Prevalence, Predictive Factor, and Clinical Significance of White-Coat Hypertension and Masked Hypertension in Korean Hypertensive patients
Eui-Seock Hwang, M.D.A1
Kee-Joon Choi, M.D.A1
Duk-Hyun Kang, M.D.A1
Gi-Byoung Nam, M.D.A1
Jae-Sik Jang, M.D.A1
Young-Hoon Jeong, M.D.A1
Chang-Hoon Lee, M.D.A1
Ji-Young Lee, M.D.A1
Hyun-Koo Park, M.D.A1
Chong-Hun Park, M.D.A1
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Correspondence: Correspondence to: Chong-Hun Park, M.D. Division of Cardiology, Department of Internal Medicine Ulsan University College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Korea. Tel: 82-2-3010-3156, Fax: 82-2-486-5918, chpark@amc.seoul.kr

INTRODUCTION

Hypertension is a risk factor for diseases of the cardiovascular system. Mean daytime ambulatory blood pressure (BP) better reflects cardiovascular risk than mean clinic BP measured in a medical office, especially since daily fluctuations in BP reflect the actual BP to which individuals are exposed. Ambulatory blood pressure monitoring (ABPM) over 24 hours is therefore an important means of diagnosing and managing hypertension1-3). With the introduction of 24-hour ABPM, conventional hypertension has been subclassified as white-coat hypertension (WCHT), in which patients exhibit elevated clinic BP but normal daytime ambulatory BP; masked hypertension (MHT), in which patients exhibit elevated daytime ambulatory BP but normal clinic BP; and sustained hypertension (SHT), in which patients exhibit elevated clinic and daytime ambulatory BP4, 5).

WCHT is present in about 7% to 12% of the general population, and in 12% to 50% among stage 1 and 2 hypertension groups by the JNC-6 guidelines6-8). Factors predictive of WCHT include female gender, low educational level, low clinic BP, smoking history, and low BMI6, 7, 9, 10). The degree of target organ damage11-15) and long-term cardiovascular risk11, 16-18) in WCHT patients is higher than normotensive (NT) subjects, but less than in subjects with SHT.

MHT is present in about 10% of patients with hypertension2, 7, 8, 19). Factors predictive of MHT include younger age, male gender, high BMI, high clinic BP, and a history of habitual drinking7, 20). Target organ damage and cardiovascular risk in subjects with MHT are similar or slightly lower than those of SHT8, 19, 21).

While measurement of ambulatory BP for 24 hours is essential to the diagnosis of WCHT or MHT, these conditions are not easy to diagnose in Korea, because measurements of daytime ambulatory BP are not yet common. Accordingly, we assessed the prevalence of WCHT and MHT in hypertensive patients who were followed-up with an ABPM device. We also determined the dynamic, demographic, and clinical factors predictive of WCHT and MHT, as well as their effects on target organ damage, in Korean subjects.


MATERIALS AND METHODS
Subjects

The subjects of this study were hypertensive patients ≥15 years old at an early stage of diagnosis who visited the outpatient unit of the Department of Cardiology at Asan Medical Center between February 2004 and October 2005, and who had undergone 24 hours of ABPM. Subjects with serious cardiovascular complications, such as coronary artery disease and stroke, at their first visit were excluded.

Methods

Demographic characteristics recorded at the first visit included age, sex, height, weight, medication, smoking history, drinking history, combined diseases, and a family history of hypertension. Blood was drawn for measurement of total serum cholesterol, triglycerides, HDL and LDL cholesterol, blood sugar, creatinine, and uric acid. Echocardiographic exams were done, depending on the doctor's decision, to obtain the left ventricular mass index (LVMI) and aortoseptal angle (AoSA). LVMI was calculated by dividing the left ventricular muscles by surface area22), and AoSA was measured from the parasternal long-axis view immediately before the opening of the aortic valve, with AoSA increases defined as over 12023).

Clinic BP and 24-hour ABPM were measured using standard procedures. If subjects were taking antihypertensive medications, they were stopped for 3 to 7 days prior to measurements of clinic BP and 24-hour ABPM. Based on mean daytime blood pressure (6 am to 10 pm) of clinic BP and 24-hour ABPM, subjects were classified into four groups4, 5).

(1) Normotension (NT)

Clinic BP < 140/90 mmHg and daytime BP < 135/85 mmHg

(2) Masked hypertension (MHT)

Clinic BP < 140/90 mmHg and daytime BP ≥ 135 mmHg or 85 mmHg

(3) White-coat hypertension (WCHT)

Clinic BP ≥ 140 or 90 mmHg and daytime BP < 135/85 mmHg

(4) Sustained hypertension (SHT)

Clinic BP ≥ 140 or 90 mmHg and daytime BP ≥135 mmHg or 85 mmHg

Statistical Methods

Continuous variables are represented as mean standard deviation, and categorical variables as frequency and percentage. Pearson's correlation coefficient analysis was used to assess correlations between blood pressure and LVMI. The NT and MHT groups, and the SHT and WCHT were compared using chi-square tests for categorical variables and Student's t-test for continuous variables. Multivariate logistic regression analysis was used to determine whether any baseline demographic or clinical factors were predictive of MHT and WCHT. All statistical analyses were performed using SPSS 12.0 for Windows. A p-value < 0.05 was defined as statistically significant.


RESULTS
Baseline characteristics

The mean age of the 967 subjects was 51.9±11.9 years. Of these individuals, 52% were male, 32% were current smokers, and 41.9% were habitual drinkers. In addition, 87.1% (886) were taking one or more antihypertensive medications, and 13.7% had a family history of hypertension. Overall, the mean clinic BP was 157.7±22.0/95.3±13.1 mmHg, and the mean daytime ambulatory BP was 136.4±15.0/ 86.2±10.7 mmHg. The NT, MHT, WCHT, and SHT groups consisted of 51 (5.3%), 55 (5.7%), 273 (28.2%), and 588 (60.8%) subjects, respectively (Table 1).

Compared with the NT group, the MHT group had a lower mean age, higher mean body mass index, and higher percentages of males and habitual drinkers (p<0.05 each). In contrast, the WCHT group had a higher percentage of females, a lower mean body mass index, and lower percentages of current smokers and habitual drinkers than the SHT group (p<0.05 each).

Echocardiographic Findings

The SHT group had a significantly higher LVMI than the WCHT group (p<0.05), but LVMI was not significantly different in the NT and MHT groups. LVMI showed significant positive correlations with both cli0nic BP (r=0.305, p<0.001) and mean daytime ambulatory BP (r=0.175, p<0.001) (Figure 1). There were no significant differences in the percentage of patients with increased AoSA.

'Masked Effect' and 'White Coat Effect'

There were significant negative correlations between clinic BP and mean daytime ambulatory BP minus clinic BP (awake ABPM-clinic BP) for both systolic (r=-0.8, p<0.001) and diastolic (r=-0.6, p<0.001) blood pressure. The white-coat effect was clear among the subjects who exhibited high clinic BP, while the masked effect was clear among subjects who exhibited low clinic BP.

Predictive Factors

We used univariate logistic regression analysis to identify predictive factors for MHT and WCHT. Factors predictive of MHT included younger age, male gender, higher body mass index, clinic BP ≥130 mmHg that did not meet hypertension criteria, and habitual drinking (Table 3). Factors predictive of WCHT included female gender, lower body mass index, and clinic BP that met the hypertension criteria but <150 mmHg (Table 4). Multivariate logistic regression analysis showed that factors significantly predictive of MHT were male gender, higher body mass index, and clinic BP ≥130 mmHg, and that factors significantly predictive of WCHT were female gender, lower body mass index, and clinic BP <150 mmHg.


DISCUSSION

Large-scale studies in western countries on WCHT and MHT have led to JNC-7 and ESC-ESH guidelines recommending the use of ABPM for 24 hours24-26). However, ABPM is not widely used in Korea, and their prevalence is not known. Here, we assessed 24-hour ABPM in almost 1000 Korean subjects to determine the prevalence of both WCHT and MHT.

Cardiovascular risk is considerably reduced if mean daytime blood pressure, determined by ABPM, is lower than 135/85 mmHg, establishing this as the normal upper limit of ABPM10, 26-29). However, many previous studies defined it as under 125/80 mmHg, leading to differences in estimates of WCHT prevalence: from around 10% in the general population and 15% to 50% among those with slightly elevated blood pressure. Its prevalence among Koreans with early stage hypertension was 28.2%, perhaps due to the fact that they were mildly hypertensive patients.

MHT, previously called 'white-coat normotension' or 'reversed WCHT', was first described as a phenomenon of normal clinic BP and high daytime ambulatory BP4, 30). Its prevalence ranges from 9% to 13.4% in the general population8, 19) and from 7% to 22.9% in hypertensive patients2, 7). The prevalence of MHT observed in this study was somewhat lower, 5.7%, probably because fewer young patients were included in the study, and therefore may not reflect primary medical practice. Furthermore, since this was not a random prospective study, we cannot exclude the possibility that MHT patients with normal clinic BP were no longer followed-up.

LVMI correlates significantly with 24-hour daytime ambulatory BP in hypertensive subjects31), and 24-hour daytime ambulatory BP better reflects cardiovascular risk than clinic BP2, 3). We also found significant correlations between 24-hour daytime ambulatory BP and echocardiographically-determined LV hypertrophy and LVMI. In contrast to previous studies13, 15, 19), however, we did not detect clear differences among the four blood pressure groups. This may have been due to the relatively low number of patients in each group, although we cannot exclude the possibility that LV hypertrophy in some patients was affected by their past medication history. It should be noted, however, that all of our subjects were recently diagnosed. Prospective studies in large numbers of subjects are needed to determine causal relationships between BP and LV hypertrophy, as well as to determine if target organ damage affects long-term prognosis.

While the percentage of patients with AoSA increases significantly with age, there were no significant differences among the four blood pressure groups, perhaps because we did not measure the exact angle.

We also assessed factors that could distinguish between NT and MHT or between WCHT and SHT, which cannot be differentiated by clinic BP. In agreement with previous studies6, 7, 9, 10, 20), we found that factors significantly predictive of MHT were younger age, male gender, higher body mass index, and clinic BP ≥130 mmHg, while the factors significantly predictive of WCHT were female gender, lower body mass index, and hypertensive clinic BP <150 mmHg. Nicotine-induced hyperfunction of the sympathetic nerve caused by smoking contracts the peripheral vascular system and raises BP for about 30 minutes32, 33). Since continual smoking raises daytime ambulatory BP and since subjects may temporarily stop smoking before visiting the clinic, measured clinic BP may be lower than daytime ambulatory BP. Thus, a previous study reported that smoking is predictive of MHT, whereas not smoking is predictive of WCHT9). Although we found that smoking status was not predictive of WCHT or MHT, smoking may distinguish among hypertensive groups because the percentage of smokers in the WCHT group was significantly lower than that in the SHT group.

Whereas some studies measured clinic BP two to three times per subject and averaged these values7, 8), we measured clinic BP only once. Our procedure may have introduced an error in the diagnosis of WCHT by failing to reduce the white coat effect. Furthermore, the ABPM effect, in which average blood pressure increased 7/4 mmHg for the first four hours after wearing an ABPM device34), could cause errors in diagnosis. Therefore, randomized, prospective studies, in which clinic BP is determined by measuring BP twice for each of three visits35), and in which daytime ambulatory BP is determined by performing ABPM for 48 hours and taking the results for the second day, may more accurately determine the correlations among prevalence rates of MHT and WCHT, target organ damage, and cardiovascular risk.

In conclusion, we found that the prevalence rates of WCHT and MHT among Korean hypertensive patients were similar to those in western countries. ABPM is essential for diagnosing such patients, and better reflects target organ damage such as LV hypertrophy. These findings indicate that ABPM should be used to determine factors predictive of WCHT and MHT, thus enabling early detection of high risk patients and providing them with proper treatment.


References
1. Perloff D,Sokolow M,Cowan R. The prognostic value of ambulatory blood pressuresJAMA 1983;249:2792–2798. [pmid: 6842787]
2. Clement DL,De Buyzere ML,De Bacquer DA,de Leeuw PW,Duprez DA,Fagard RH,Gheeraert PJ,Missault LH,Braun JJ,Six RO,van der Niepen P,O'Brien E. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertensionN Engl J Med 2003;348:2407–2415. [pmid: 12802026]
3. Hansen TW,Jeppesen J,Rasmussen S,Ibsen H,Torp-Pedersen C. Ambulatory blood pressure and mortality: a population-based studyHypertension 2005;45:499–504. [pmid: 15753229]
4. Pickering TG,Davidson K,Gerin W,Schwartz JE. Masked hypertensionHypertension 2002;40:795–796. [pmid: 12468559]
5. Hedner T,Himmelmann A,Kjeldsen SE. Masked hypertension: a new entity and challenge for clinical hypertension research and managementBlood Press 2003;12:261–263. [pmid: 14763655]
6. Martinez MA,Garcia-Puig J,Martin JC,Guallar-Castillon P,Aguirre de Carcer A,Torre A,Armada E,Nevado A,Madero RS. Frequency and determinants of white coat hypertension in mild to moderate hypertension: a primary care-based studyAm J Hypertens 1999;12:251–259. [pmid: 10192226]
7. Obara T,Ohkubo T,Funahashi J,Kikuya M,Asayama K,Metoki H,Oikawa T,Hashimoto J,Totsune K,Imai Y. Isolated uncontrolled hypertension at home and in the office among treated hypertensive patients from the J-HOME studyJ Hypertens 2005;23:1653–1660. [pmid: 16093909]
8. Ohkubo T,Kikuya M,Metoki H,Asayama K,Obara T,Hashimoto J,Totsune K,Hoshi H,Sato H,Imai Y. Prognosis of "masked" hypertension and "white-coat" hypertension detected by 24-h ambulatory blood pressure monitoring 10-year follow-up from the Ohasama studyJ Am Coll Cardiol 2005;46:508–515. [pmid: 16053966]
9. Verdecchia P,Palatini P,Schillaci G,Mormino P,Porcellati C,Pessina AC. Independent predictors of isolated clinic (white-coat) hypertensionJ Hypertens 2001;19:1015–1020. [pmid: 11403348]
10. O'Brien E,Asmar R,Beilin L,Imai Y,Mallion JM,Mancia G,Mengden T,Myers M,Padfield P,Palatini P,Parati G,Pickering T,Redon J,Staessen J,Stergiou G,Verdecchia P. European Society of Hypertension Working Group on Blood Pressure Monitoring. European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurementJ Hypertens 2003;21:821–848. [pmid: 12714851]
11. Khattar RS,Senior R,Lahiri A. Cardiovascular outcome in white-coat versus sustained mild hypertension: a 10-year follow-up studyCirculation 1998;98:1892–1897. [pmid: 9799210]
12. Karter Y,Curgunlu A,Altinisik S,Erturk N,Vehid S,Mihmanli I,Ayan F,Kutlu A,Arat A,Ozturk E,Erdine S. Target organ damage and changes in arterial compliance in white coat hypertension: is white coat innocent?Blood Press 2003;12:307–313. [pmid: 14763662]
13. Palatini P,Mormino P,Santonastaso M,Mos L,Dal Follo M,Zanata G,Pessina AC. Target-organ damage in stage I hypertensive subjects with white coat and sustained hypertensionHypertension 1998;31:57–63. [pmid: 9449391]
14. Muldoon MF,Nazzaro P,Sutton-Tyrrell K,Manuck SB. White-coat hypertension and carotid artery atherosclerosis: a matching studyArch Intern Med 2000;160:1507–1512. [pmid: 10826466]
15. Nakashima T,Yamano S,Sasaki R,Minami S,Doi K,Yamamoto J,Takaoka M,Saito Y. White-coat hypertension contributes to the presence of carotid arteriosclerosisHypertens Res 2004;27:739–745. [pmid: 15785009]
16. Pierdomenico SD,Lapenna D,Bucci A,Di Iorio A,Neri M,Cuccurullo F,Mizzetti A. Cardiovascular and renal events in uncomplicated mild hypertensive patients with sustained and white coat hypertensionAm J Hypertens 2004;17:876–881. [pmid: 15485748]
17. Celis H,Staessen JA,Thijs L,Buntinx F,De Buyzere M,Den Hond E,Fagard RH,O'Brien ET. Cardiovascular risk in white-coat and sustained hypertensive patientsBlood Press 2002;11:352–356. [pmid: 12523678]
18. Gustavsen PH,Hoegholm A,Bang LE,Kristensen KS. White coat hypertension is a cardiovascular risk factor: a 10-year follow-up studyJ Hum Hypertens 2003;17:811–817. [pmid: 14704724]
19. Sega R,Trocino G,Lanzarotti A,Carugo S,Cesana G,Schiavina R,Valagussa F,Bombelli M,Giannattasio C,Zanchetti A,Mancia G. Alterations of cardiac structure in patients with isolated office, ambulatory, or home hypertensionCirculation 2001;104:1385–1392. [pmid: 11560854]
20. Messerli FH,Cotiga D. Masked hypertension and white-coat hypertension: therapeutic navigation between Scylla and CharybdisJ Am Coll Cardiol 2005;46:516–517. [pmid: 16053967]
21. Pierdomenico SD,Lapenna D,Bucci A,Di Tommaso R,Di Mascio R,Manente BM,Caldarella MP,Neri M,Cuccurullo F,Mezzetti A. Cardiovascular outcome in treated hypertensive patients with responder, masked, false resistant, and true resistant hypertensionAm J Hypertens 2005;18:1422–1428. [pmid: 16280275]
22. Devereux RB,Alonso DR,Lutas EM,Gottlieb GJ,Campo E,Sachs I,Reichek N. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findingsAm J Cardiol 1986;57:450–458. [pmid: 2936235]
23. Fowles RE,Martin RP,Popp RL. Apparent asymmetric hypertrophy due to angled interventricular septumAm J Cardiol 1980;46:386–392. [pmid: 7191198]
24. Chobanian AV,Bakris GL,Black HR,Cushman WC,Green LA,Izzo JL Jr,Jones DW,Materson BJ,Oparil S,Wright JT Jr,Roccella EJ. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 reportJAMA 2003;289:2560–2572. [pmid: 12748199]
25. European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertensionJ Hypertens 2003;21:1011–1053. [pmid: 12777938]
26. O'Brien E,Asmar R,Beilin L,Imai Y,Mancia G,Mengden T,Myers M,Padfield P,Palatin P,Parati G,Pickering T,Redon J,Staessen J,Stergiou G,Verdecchia P. Practice guidelines of the European Society of Hypertension for clinic, ambulatory and self blood pressure measurementJ Hypertens 2005;23:697–701. [pmid: 15775768]
27. Verdecchia P,Reboldi G,Porcellati C,Schillaci G,Pede S,Bentivoglio M,Angeli F,Norgiolini S,Ambrosio G. Risk of cardiovascular disease in relation to achieved office and ambulatory blood pressure control in treated hypertensive subjectsJ Am Coll Cardiol 2002;39:878–885. [pmid: 11869856]
28. Hozawa A,Ohkubo T,Obara T,Metoki H,Kikuya M,Asayama K,Totsune K,Hashimoto J,Hoshi H,Arai Y,Satoh H,Hosokawa T,Imai Y. Introversion associated with large differences between screening blood pressure and home blood pressure measurementJ Hypertens 2006;24:2183–2189. [pmid: 17053539]
29. Pickering T. Recommendations for the use of home (self) and ambulatory blood pressure monitoringAm J Hypertens 1996;9:1–11. [pmid: 8834700]
30. Devereux RB,Pickering TG. O'Brien E,O'Malley KAmbulatory blood pressure in assessing the cardiac impact and prognosis of hypertensionBlood pressure measurement. Handbook of Hypertension 1991:261–285.
31. Verdecchia P,Schillaci G,Borgioni C,Ciucci A,Porcellati C. White-coat hypertension: not guilty when correctly definedBlood Press Monit 1998;3:147–152. [pmid: 10212345]
32. Mann SJ,James GD,Wang RS,Pickering TG. Elevation of ambulatory systolic blood pressure in hypertensive smokers: a case-control studyJAMA 1991;265:2226–2228. [pmid: 2013955]
33. Mancia G. Reversed white-coat hypertension: definition, mechanisms and prognostic implicationsJ Hypertens 2002;20:579–581. [pmid: 11910284]
34. Hermida RC,Calvo C,Ayala DE,Fernandez JR,Ruilope LM,Lopez JE. Evaluation of the extent and duration of the "ABPM effect" in hypertensive patientsJ Am Coll Cardiol 2002;40:710–717. [pmid: 12204501]
35. Fagard RH,Staessen JA,Thijs L. Prediction of cardiac structure and function by repeated clinic and ambulatory blood pressureHypertension 1997;29:22–29. [pmid: 9039075]

Article Categories:
  • Original Article

Keywords: White-coat hypertension, Masked hypertension, Ambulatory BP monitoring.

Previous Document:  Effects of TNF-alpha and leptin on weight loss in patients with stable chronic obstructive pulmonary...
Next Document:  Expression of c-FLIP in gastric cancer and its relation to tumor cell proliferation and apoptosis.