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White coat effect and masked uncontrolled hypertension in treated hypertensive-diabetic patients: Prevalence and
Liana F Leiria1, Mateus D Severo2, Priscila S Ledur2
1Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Insights
In diabetic patients on treatment, masked uncontrolled hypertension (MUH) was more prevalent than expected. Different hypertension phenotypes showed varying associations with left ventricle hypertrophy but not clearly with kidney or diastolic function.
Area of Science:
- Cardiology
- Nephrology
- Endocrinology
Background:
- The association between hypertensive phenotypes (controlled hypertension, white-coat effect, masked uncontrolled hypertension, sustained hypertension) and target organ damage in treated diabetic hypertensive patients is not well-established.
- Current cut-off points for office and 24-hour ambulatory blood pressure monitoring (ABPM) may influence these associations.
Purpose of the Study:
- To evaluate the prevalence of four hypertensive phenotypes in treated diabetic patients using current ABPM cut-off points.
- To assess the association of these phenotypes with left ventricle hypertrophy (LVH), diastolic function, and nephropathy.
Main Methods:
- A cross-sectional study involving 304 treated hypertensive diabetic patients (mean age 57.6 years).
- Patients underwent 24-hour ABPM and echocardiography.
- Hypertensive phenotypes were classified based on office and ABPM readings: CH, WCE, MUH, and SH.
Main Results:
- Prevalences were: sustained hypertension (SH) 36.8%, controlled hypertension (CH) 27.3%, masked uncontrolled hypertension (MUH) 18.8%, and white-coat effect (WCE) 17.1%.
- MUH prevalence was higher than previously reported.
- A significant increasing trend in left ventricle hypertrophy (LVH) was observed across the four groups (P < 0.001).
- No clear dose-response relationship was found between phenotypes and nephropathy or diastolic function.
Conclusions:
- Ambulatory blood pressure monitoring (ABPM) is valuable for risk stratification in high-risk patients, despite limitations.
- Longitudinal studies are needed to further clarify the role of ABPM.
- The choice of normality cut-off points for office and ABPM significantly impacts the prevalence of white-coat hypertension (WCH) and MUH.
Background:
The association between hypertensive phenotypes of controlled hypertension (CH), white-coat effect (WCE), masked uncontrolled hypertension (MUH) and sustained hypertension (SH) with target organ damage have not been clearly established in diabetic hypertensive treated patients. The present study aims to evaluate the prevalence of the four phenotypes considering the current cut-off points for office and 24 h-ambulatory blood pressure monitoring (ABPM) and the association with left ventricle hypertrophy (LVH), diastolic function and nephropathy.
Methods:
Cross-sectional study with 304 patients on anti-hypertensive treatment aged 57.6 ± 6.1 years, who were submitted to ABPM and echocardiography. They were classified into CH (normal office BP and ABPM), WCE (high office BP and normal ABPM), MUH (normal office BP and high ABPM), and SH (high office BP and ABPM).
Results:
Median HbA1c and diabetes duration were 7.9% (6.8-9.2), and 10 years (5-16), respectively. Prevalences of CH, WCE, MUH and SH were 27.3%, 17.1%, 18.8%, and 36.8%. MUH prevalence was higher than previously described. There was a significant increasing trend across the four groups in variables related to LVH (P < 0.001 for trend). There was not a clear "dose-response" relationship of the four hypertensive phenotypes with nephropathy and diastolic function.
Conclusion:
The use of ABPM beyond the traditional cardiovascular risk stratification tools has limitations, but is still useful in high-risk patients. Longitudinal studies could better evaluate the role of the use of ABPM in this scenario. Cut-off points for normality of office and ABPM influence the prevalences of WCH and MUH.
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