Related Experiment Video
Updated: May 8, 2025
Author Spotlight: Exploring Huotan Jiedu Tongluo Decoction as an Antihypertensive Drug
Published on: May 17, 2024
Different phenotypes of hypertension and associated cardiovascular and all-cause mortality: a systematic review and
Jay Tewari1, Khalid Ahmad Qidwai2, Shubhajeet Roy1
1King George's Medical University, Lucknow, India.
Insights
Masked hypertension and sustained hypertension significantly increase cardiovascular mortality risk. Out-of-office blood pressure monitoring is crucial for identifying these high-risk hypertension phenotypes.
Area of Science:
- Cardiology
- Preventive Medicine
- Epidemiology
Background:
- Hypertension is a major cause of premature death and illness.
- Out-of-office blood pressure monitoring (ambulatory and home BP) is recommended to detect hypertension phenotypes.
- Clinical inertia hinders adoption due to limited evidence on phenotype-specific mortality risks.
Purpose of the Study:
- To systematically review and meta-analyze the association between hypertension phenotypes and cardiovascular/all-cause mortality.
- To provide evidence supporting the use of out-of-office BP monitoring for risk stratification.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA, Cochrane, and MOOSE guidelines.
- Searched major databases (PubMed, OvidSP, Cochrane Central) up to October 2023.
- Pooled hazard ratios from 8 studies (15,327 participants) using random-effects models.
Main Results:
- Masked hypertension (HR 2.05) and sustained hypertension (HR 2.42) significantly increased cardiovascular mortality versus normotension.
- White coat hypertension showed no significant increase in cardiovascular mortality (HR 1.18).
- No significant increase in all-cause mortality was observed for masked or white coat hypertension.
Conclusions:
- Masked and sustained hypertension are associated with elevated cardiovascular mortality.
- Out-of-office BP monitoring is vital for identifying and managing these high-risk phenotypes.
- Further research is needed to confirm findings and inform policy.
Background:
Hypertension is a leading cause of premature mortality and morbidity. Recent guidelines advocate for out-of-office blood pressure monitoring, including ambulatory and home BP monitoring, to better identify hypertension phenotypes like masked hypertension, white coat hypertension, and sustained hypertension. However, clinical inertia persists due to a lack of robust evidence on the effectiveness of screening these phenotypes and their association with cardiovascular and all-cause mortality. This systematic review and meta-analysis aims to evaluate the relationship between various hypertension phenotypes and future cardiovascular events and all-cause mortality to support the broader implementation of out-of-office BP monitoring.
Main Body:
Following PRISMA, Cochrane, and MOOSE guidelines, we conducted a comprehensive search in Pubmed, OvidSP, and Cochrane Central databases up to October 17, 2023. Eligible studies reported associations between hypertension phenotypes and cardiovascular or all-cause mortality, with normotension as the reference group. Hazard ratios with 95% confidence intervals (CIs) were pooled using random-effects models. Eight studies with 15,327 participants were included. Masked hypertension was associated with increased cardiovascular mortality (pooled HR 2.05, 95% CI 1.69-2.48). Sustained hypertension also showed a higher risk (pooled HR 2.42, 95% CI 2.12-2.76). WCH did not significantly increase cardiovascular mortality risk (pooled HR 1.18, 95% CI 0.98-1.42). For all-cause mortality, neither masked hypertension (pooled HR 2.10, 95% CI 0.91-4.88) nor white coat hypertension (pooled HR 1.96, 95% CI 0.71-5.42) showed significant increases.
Conclusion:
Masked hypertension and sustained hypertension are linked to higher cardiovascular mortality compared to normotension, highlighting the importance of out-of-office BP monitoring to identify and manage high-risk phenotypes effectively. Further high-quality studies are needed to generalize these findings and support policy changes.
Related Concept Videos
01:18Hypertension and Regulation of Blood Pressure
01:28Factors affecting Blood pressure
Physiological Factors:
01:30Alterations in Blood Pressure
Hypertension (High blood pressure)
Hypertension occurs when blood pressure readings consistently exceed the normal range. It is diagnosed when systolic blood pressure (the top number, indicating pressure while the heart...
01:18Disorders of the Autonomic Nervous System
Raynaud's disease, also known as Raynaud's...
01:17Pathophysiology of Heart Failure
01:27Psychoneuroimmunology: Cardiovascular Disease
A key area of focus in PNI is the relationship between stress and coronary...