Blood pressure phenotypes and hypertension-associated cardiac damage

The aim of this study was to characterize hypertension-associated cardiac damage in the blood pressure (BP) phenotypes sustained normotension (SNT), white coat hypertension (WCHT), masked hypertension (MHT) and sustained hypertension (SHT).

In a population-based study, 4115 individuals were examined with office and home BP measurement, computed tomography, coronary computed tomography angiography and echocardiography. The odds ratios of hypertension-associated cardiac damage in the BP phenotypes were analysed with SNT and SHT as references, respectively, for coronary artery calcium score (CACS) at least 100 and at least 300, Segment Involvement Score (SIS) at least 4, any significant (>50%) coronary stenosis, left ventricular ejection fraction (LVEF) less than 50%, E/e΄ ratio (E/e΄) at least 14, and global longitudinal strain (GLS) greater than -17 (men) or greater than -18 (women).

The odds of having hypertension-associated cardiac damage were significantly higher for WCHT than for SNT [LVEF < 50%: OR 1.83 (1.17-2.86), CACS ≥ 100: OR 1.58 (1.19-2.11)], and for SHT than for SNT [LVEF < 50%: OR 2.34 (1.53-3.57), CACS ≥ 100: OR 1.52 (1.14-2.02)]. The odds of having hypertension-associated cardiac damage were also significantly higher for MHT than for SNT (LVEF < 50%: OR 2.68 (1.41-5.10), CACS ≥ 100: OR 2.15 (1.37-3.38) and CACS ≥ 300: OR 2.34 (2.21-4.52)].

The prevalence of hypertension-associated cardiac damage was higher in WCHT and in MHT compared to SNT. WCHT and MHT should therefore be considered when assessing cardiovascular risk, and BP should be measured both in the office and at home when diagnosing and monitoring hypertension.