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Variability between current definitions of 'normal' ambulatory blood pressure. Implications in the assessment of
P Verdecchia1, G Schillaci, F Boldrini
1General Hospital R. Silvestrini, Division of Medicine, Perugia, Italy.
Insights
Defining normal ambulatory blood pressure limits significantly impacts white coat hypertension prevalence and left ventricular hypertrophy. Different standards reveal varying prevalence rates and associated cardiac changes in hypertensive patients.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Criteria
Background:
- The accurate diagnosis of white coat hypertension is hindered by the absence of universally accepted normal limits for ambulatory blood pressure.
- Variability in diagnostic criteria can influence the perceived prevalence of white coat hypertension and its association with target organ damage.
Purpose of the Study:
- To evaluate how four different upper limits of normal for daytime ambulatory blood pressure affect the prevalence of white coat hypertension.
- To assess the impact of these varying diagnostic standards on the distribution of left ventricular hypertrophy in patients with essential hypertension.
Main Methods:
- Conducted 24-hour ambulatory blood pressure monitoring in 346 untreated patients with essential hypertension and 47 age-matched normotensive controls.
- Performed echocardiographic studies to measure left ventricular mass index and assess left ventricular hypertrophy.
- Analyzed data using four distinct sets of upper normal limits for daytime ambulatory blood pressure.
Main Results:
- The upper limits of normal for daytime ambulatory blood pressure were lower when using standards derived from clinically normotensive populations compared to general populations.
- The prevalence of white coat hypertension varied substantially across the four standards, ranging from 12.1% to 53.2%.
- Higher prevalence of left ventricular hypertrophy was observed when using stricter (lower) blood pressure standards for defining white coat hypertension.
Conclusions:
- The choice of normal limits for ambulatory blood pressure critically influences the diagnosis and prevalence of white coat hypertension.
- Diagnostic standards derived from normotensive populations may lead to a more accurate identification of white coat hypertension and its association with cardiac remodeling.
- Further research is needed to establish standardized criteria for ambulatory blood pressure to ensure consistent diagnosis and management of hypertension.
Abstract:
The assessment of white coat hypertension is complicated by the lack of generally agreed-on normal limits of ambulatory blood pressure. To assess the influence of four of these limits on the prevalence of white coat hypertension and the corresponding distribution of left ventricular hypertrophy, we performed 24-hour ambulatory blood pressure monitoring and echocardiographic studies in 346 untreated patients with essential hypertension and 47 age-matched normotensive control subjects. The upper limits of normal daytime ambulatory blood pressure were lower using standards drawn from clinically normotensive populations than using standards drawn, partly or entirely, from general populations. The prevalence of white coat hypertension differed markedly using the different standards, being 12.1%, 16.5%, 28.9%, and 53.2% (chi 2 = 346.0, p less than 0.0001). Left ventricular mass index averaged 77 g/m2 in the control group, 85 g/m2 in the two groups with white coat hypertension defined by using standards drawn from normotensive populations (both comparisons not significant versus control group), and 90 and 98 g/m2 in the two groups with white coat hypertension defined by using the other two standards (both p less than 0.01 versus control group). The prevalence of echocardiographic left ventricular hypertrophy was 0% in the control group, 2.4% and 3.5% in the two groups with white coat hypertension defined by using standards drawn from normotensive populations, and 9.0% and 14.7% in the other two groups with white coat hypertension (p less than 0.05 and p less than 0.01, respectively, versus control group).(ABSTRACT TRUNCATED AT 250 WORDS)
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