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Published on: May 17, 2024
Insights
White-coat hypertension (WCH) and masked hypertension (MH) are common, affecting prognosis and cardiovascular risk. Early detection through out-of-office blood pressure monitoring is crucial for timely intervention.
Area of Science:
- Cardiology
- Hypertension Research
Background:
- White-coat hypertension (WCH) affects one-third of individuals with high office blood pressure (BP), often presenting in older, non-smoking females.
- Masked hypertension (MH) has a prevalence of 13%, commonly seen in younger, male smokers with risk factors, and in diabetics.
Purpose of the Study:
- To highlight the prevalence and characteristics of WCH and MH.
- To emphasize the importance of out-of-office blood pressure monitoring for diagnosing MH and assessing cardiovascular risk.
Main Methods:
- Review of existing literature on WCH and MH prevalence, patient profiles, and prognostic data.
- Discussion of diagnostic challenges and treatment considerations for both conditions.
Main Results:
- WCH patients may have increased cardiovascular risk compared to normotensives, though data is limited.
- MH patients face cardiovascular event risks comparable to sustained hypertensives, necessitating active screening.
Conclusions:
- Routine home blood pressure monitoring is recommended for individuals with normal office BP to detect MH.
- Treatment strategies for WCH and MH lack prospective data, with non-pharmacologic approaches for low-risk individuals and empirical drug treatment for high-risk patients, requiring close monitoring.
Abstract:
White-coat hypertension (WCH) is very common: it is present in about one third of subjects with high office blood pressure (BP). A typical patient is a non-smoking female at higher age. Prognostic data are not very reliable because most patients are treated on the basis of elevated office BP; some long-term studies have shown that cardiovascular (CV) risk is increased compared to normotensives. The opposite disorder is masked hypertension (MH). Its prevalence in population-based studies is 13 %. MH is common in males, typically aged between 30 and 50 years, smokers with unfavorable risk profile, and it is also frequent in diabetics. The risk of future cardiovascular events is close to that of sustained hypertensives. It is important to search for MH actively, therefore, we should recommend home BP measurements also to those subjects whose office BP is normal. We do not have any prospective data about treatment of either WCH or MH. In subjects with low CV risk, only nonpharmacologic treatment may be initiated - in this case, however, the patient must be followed closely including out-of-office BP measurements; in those subjects where other CV risk factors and/or target organ damage are present, drug treatment should be considered, but as we have no evidence, only empirical approach is possible.Key words: ambulatory blood pressure monitoring - diagnosis - masked hypertension - prognosis - treatment - white-coat hypertension.
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