Target organ damage and masked hypertension in the general population: the Finn-Home study.

BACKGROUND: The relation of masked hypertension to target organ damage has very seldom been investigated in a general population. METHODS: An unselected population cohort (n = 1989 of which 1540 were not treated for hypertension) underwent office (duplicate measurements on one visit by a nurse) and home (duplicate measurements on 7 days) blood pressure (BP) measurements and evaluation of electrocardiographic left ventricular hypertrophy (ECG-LVH, n = 1989/1540), carotid intima-media thickness (cIMT, n = 758/592), and pulse wave velocity (PWV, n = 237/158). ECG-LVH was diagnosed using Cornell voltage criteria. PWV was measured using whole-body impedance cardiography. Masked hypertension was defined as office BP less than 140/90 mmHg with home BP at least 135/85 mmHg and white-coat hypertension as office BP at least 140/90 mmHg and home BP less than 135/85 mmHg. RESULTS: Masked and sustained hypertensive individuals had significantly higher age-adjusted and sex-adjusted Cornell voltage, cIMT, and PWV than normotensive individuals. White-coat hypertensive patients had higher age-adjusted and sex-adjusted Cornell voltage than normotensive individuals but significantly lower Cornell voltage and PWV than sustained hypertensive patients. The differences in Cornell voltage and PWV remained significant after adjustment for confounding factors. However, all differences became nonsignificant after adjustment for systolic home BP. CONCLUSION: Masked and sustained hypertension is accompanied by increased risk for hypertensive target organ damage, whereas white-coat hypertension seems to be a more benign phenomenon.

Prognostic significance of masked and white-coat hypertension in the general population: the Finn-Home Study.

OBJECTIVE: The clinical significance of masked and white-coat hypertension is still somewhat controversial. The aim of the present study was to investigate the prognosis of masked and white-coat hypertension using home blood pressure (BP) measurement. DESIGN AND METHODS: A nationwide population sample (n = 2046, age 44-74 years) underwent office (duplicate measurements on one visit by a nurse) and home (duplicate measurements on 7 days) BP measurements and risk factor evaluation. During the follow-up of 7.5 years, 221 fatal and nonfatal cardiovascular events and 142 all-cause deaths occurred. Masked hypertension was defined as office BP less than 140/90 mmHg with home BP at least 135/85 mmHg. RESULTS: The prevalence of baseline risk factors and the incidence of cardiovascular events and all-cause deaths increased from normotension to white-coat, masked and sustained hypertension. Unadjusted hazard ratios for white-coat hypertension were 1.18 (P = 0.5) for cardiovascular events and 1.23 (P = 0.5) for all-cause deaths. Masked hypertension had a significantly higher age-adjusted risk of cardiovascular events and a higher risk of all-cause mortality after adjustment for age, sex and office BP than normotension (hazard ratios 1.64, P = 0.05, and 2.09, P = 0.01). Masked hypertension lost its predictive significance after adjustment for home BP or concomitant other cardiovascular risk factors. CONCLUSION: Neither masked nor white-coat hypertension was an independent predictor of cardiovascular risk or all-cause mortality when concomitant other risk factors or baseline home BP levels were taken into account. The present study suggests that home BP level, along with other traditional risk factors, may be enough to stratify cardiovascular risk.

Determinants of masked hypertension in the general population: the Finn-Home study.

INTRODUCTION: Home blood pressure (BP) measurement has allowed the identification of individuals with normal office and elevated out-of-office BP (masked hypertension). It is, however, not feasible to measure home BP on all office normotensive individuals. The objective of the present study was to identify demographic, lifestyle, clinical and psychological characteristics suggestive of masked hypertension. METHODS: Study population was drawn from the participants of a multidisciplinary epidemiological survey, the Health 2000 Study. The untreated nationwide population sample (n = 1459, age 45-74 years) underwent office (duplicate measurements on one visit) and home (duplicate measurements on 7 days) BP measurements and risk factor evaluation. Psychometric tests assessed psychological distress, hypochondriasis, depression and alexithymia. Masked hypertension was defined as normal office BP (<140/90 mmHg) with elevated home BP (≥135/85 mmHg). RESULTS: The prevalence of masked hypertension was 8.1% in the untreated Finnish adult population. The cardiovascular risk profile of masked hypertensive patients resembled that of sustained hypertensive patients. High-normal systolic and diastolic office BP, older age, greater BMI, current smoking, excessive alcohol consumption, diabetes and electrocardiographic left-ventricular hypertrophy were independent determinants of masked hypertension in multivariate logistic regression analysis. Masked hypertension was also independently associated with hypochondria. CONCLUSION: Masked hypertension is a common phenomenon in an untreated adult population. Physicians should consider home BP measurement if a patient has high-normal office BP, diabetes, left-ventricular hypertrophy, or several other conventional cardiovascular risk factors.

Comparison of home and ambulatory blood pressure measurement in the diagnosis of masked hypertension.

INTRODUCTION: The best method to diagnose masked hypertension is controversial. The objective of the present study was to compare home blood pressure (HBP) and ambulatory blood pressure (ABP) measurement in the evaluation of masked hypertension. METHODS: Two hundred and sixty-one individuals from the general population underwent office BP (duplicate measurements on four visits), HBP (duplicate measurements on seven days) and 24-h ABP measurement, and risk factor evaluation. Target organ damage was assessed by echocardiography and 24-h urinary albumin measurement. Masked hypertension was defined as normal office BP (<140/90 mmHg) with elevated out-of-office BP (HBP >or=135/85 mmHg, daytime ABP >or=140/85 mmHg or both). RESULTS: HBP and ABP detected 10.6 and 11.4% of masked hypertension, respectively. Only 59% of patients diagnosed as masked hypertensive with ABP measurement also had masked hypertension on HBP measurement. Masked hypertensive patients had higher BMI, waist-to-hip ratio and serum insulin levels than normotensive individuals. They also had greater waist-to-hip ratio than sustained hypertensive individuals. Target organ damage in masked hypertension was between that of normotension and that of sustained hypertension. Office normotensive individuals with elevated HBP tended to have higher rates of cardiovascular risk factors and target organ damage than patients with elevated ABP. CONCLUSION: HBP and ABP detect a similar, but not an identical, group of masked hypertensive individuals. Their agreement in the diagnosis of masked hypertension is only moderate. Our results suggest that HBP measurement can be used to diagnose masked hypertension, but this diagnosis is not analogous with that made with ABP measurement.