Document Detail


Prognosis of "masked" hypertension and "white-coat" hypertension detected by 24-h ambulatory blood pressure monitoring 10-year follow-up from the Ohasama study.
MedLine Citation:
PMID:  16053966     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We sought to investigate the prognosis in subjects with "white-coat" hypertension (WCHT) and "masked" hypertension (MHT), in which blood pressure (BP) is lower in clinical measurements than during ambulatory monitoring. BACKGROUND: The prognostic significance of WCHT remains controversial, and little is known about MHT. METHODS: We obtained 24-h ambulatory BP and "casual" BP (i.e., obtained in clinical scenarios) values from 1,332 subjects (872 women, 460 men) > or =40 years old in a representative sample of the general population of a Japanese community. Survival and stroke morbidity were then followed up for a mean duration of 10 years. RESULTS: Composite risk of cardiovascular mortality and stroke morbidity examined using a Cox proportional hazards regression model for subjects with WCHT (casual BP > or =140/90 mm Hg, daytime BP <135/85 mm Hg; relative hazards [RH])1.28; 95% confidence interval [CI] 0.76 to 2.14) was no different from risk for subjects with sustained normal BP (casual BP <140/90 mm Hg, daytime BP <135/85 mm Hg). However, risk was significantly higher for subjects with MHT (casual BP <140/90 mm Hg, daytime BP > or =135/85 mm Hg; RH 2.13; 95% CI 1.38 to 3.29) or sustained hypertension (casual BP > or =140/90 mm Hg, daytime BP > or =135/85 mm Hg; RH 2.26; 95% CI 1.49 to 3.41) than for subjects with sustained normal BP. Similar findings were observed for cardiovascular mortality and stroke morbidity among subgroups by gender, use of antihypertensive medication, and risk factor level (all p for heterogeneity >0.2). CONCLUSIONS: Conventional BP measurements may not identify some individuals at high or low risk, but these people may be identifiable by the use of ambulatory BP.
Authors:
Takayoshi Ohkubo; Masahiro Kikuya; Hirohito Metoki; Kei Asayama; Taku Obara; Junichiro Hashimoto; Kazuhito Totsune; Haruhisa Hoshi; Hiroshi Satoh; Yutaka Imai
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  46     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-08-01     Completed Date:  2005-08-30     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  508-15     Citation Subset:  AIM; IM    
Affiliation:
Department of Planning for Drug Development and Clinical Evaluation, Sendai, Japan. tohkubo@mail.tains.tohoku.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Anxiety / complications
Blood Pressure Determination / methods
Blood Pressure Monitoring, Ambulatory / methods*
Cohort Studies
Confidence Intervals
Female
Humans
Hypertension / diagnosis*,  mortality,  psychology*
Japan
Longitudinal Studies
Male
Physician-Patient Relations*
Probability
Prognosis
Reproducibility of Results
Risk Assessment
Sensitivity and Specificity
Severity of Illness Index
Survival Analysis
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2005 Aug 2;46(3):516-7   [PMID:  16053967 ]
J Am Coll Cardiol. 2006 May 16;47(10):2127; author reply 2127-8   [PMID:  16697339 ]

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