Blood-pressure control in the hypertensive population

Area of Science:

• Cardiology
• Hypertension Research
• Clinical Trials

Background:

• Large-scale surveys show few hypertensive individuals achieve target blood pressure (<140/90 mm Hg) in clinic settings.
• This study investigates if the white-coat effect inflates clinic blood pressure readings, masking true control.

Purpose of the Study:

• To determine if the white-coat effect contributes to the high prevalence of uncontrolled hypertension observed in clinic settings.
• To compare clinic blood pressure with home and ambulatory blood pressure measurements to assess daily-life blood pressure control.

Main Methods:

• 1651 participants from Monza, Italy, underwent clinic, home, and 24-hour ambulatory blood pressure monitoring.
• Participants were categorized as normotensive, untreated hypertensive, or treated hypertensive based on clinic readings.
• Mean blood pressures were calculated for each group across different measurement methods.

Main Results:

• Both treated (146.9/90.2 mm Hg) and untreated (148/93.3 mm Hg) hypertensives had significantly higher clinic blood pressures than normotensives (119.5/78.1 mm Hg).
• Home and ambulatory blood pressures were lower than clinic values but remained elevated in hypertensive groups compared to normotensives.
• Few treated hypertensive patients achieved normal blood pressure levels, irrespective of measurement method (clinic vs. ambulatory).

Conclusions:

• A high proportion of hypertensive patients exhibit inadequate blood pressure control, confirmed by both clinic and ambulatory monitoring.
• The white-coat effect does not account for the elevated blood pressure readings in treated hypertensive individuals.
• Lack of daily-life blood pressure control, rather than the white-coat effect, is the main driver of high blood pressure in this population.