Short-term variability and nocturnal decline in ambulatory blood pressure in normotension, white-coat hypertension, masked hypertension and sustained hypertension: A population-based study of older individuals in Spain
Entity
UAM. Departamento de Medicina Preventiva y Salud Pública y MicrobiologíaPublisher
Nature Publishing GroupDate
2017-02-09Citation
10.1038/hr.2017.9
Hypertension Research 40.6 (2017): 613-619
ISSN
0916-9636 (print); 1348-4214 (online)DOI
10.1038/hr.2017.9Funded by
Study partially funded by FIS grant PI13/02321 and PI16/01460 (Instituto de Salud Carlos III and FEDER/FSE) and CIBERESPProject
Gobierno de España. PI13/02321; Gobierno de España. PI16/01460Editor's Version
http://doi.org/10.1038/hr.2017.9Subjects
aged; blood pressure variability; masked hypertension; population studies; white-coat hypertension; MedicinaRights
© 2017 The Japanese Society of Hypertension All rights reservedAbstract
Blood pressure (BP) variability and nocturnal decline in blood pressure are associated with cardiovascular outcomes. However, little is known about whether these indexes are associated with white-coat and masked hypertension. We performed a cross-sectional analysis of 1047 community-dwelling individuals aged ≥60 years in Spain in 2012. Three observer-measured home BPs and 24-h ambulatory blood pr essure monitoring (ABPM) were performed under standardized conditions. BP variability was defined as BP s.d. and coefficient of variation. Differences in BP variability and nocturnal BP decrease between groups were adjusted for sociodemographic and clinical covariates using generalized linear models. Of the cohort, 21.7% had white-coat hypertension, 7.0% had masked hypertension, 21.4% had sustained hypertension, and 49.9% were normotensive. Twenty-four hour, daytime and night-time systolic BP s.d. and coefficients of variation were significantly higher in subjects with white-coat hypertension than those with normotension (P < 0.05) and were similar to subjects with sustained hypertension. In untreated subjects, 24-h but not daytime or night-time BP variability indexes were significantly higher in subjects with white-coat hypertension than in those with normotension (P < 0.05). Percentage decrease in nocturnal systolic and diastolic BP was greatest in the white-coat hypertension group and lowest in the masked hypertension group in all patients and untreated patients (P < 0.05). Lack of nocturnal decline in systolic blood pressure was observed in 70.2% of subjects with normotension, 57.8% of subjects with white-coat hypertension, 78.1% of subjects with masked hypertension, and 72.2% of subjects with sustained hypertension (P < 0.001). In conclusion, 24-h BP variability was higher in subjects with white-coat hypertension and blunted nocturnal BP decrease was observed more frequently in subjects with masked hypertension. These findings may help to explain the reports of increased cardiovascular risk in patients with white-coat hypertension and poor prognosis in those with masked hypertension, highlighting the importance of ABPM
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Google Scholar:Gijón-Conde, Teresa
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Graciani Pérez-Regadera, Auxiliadora
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López García, Esther
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Guallar Castillón, María Pilar
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García García-Esquinas, Esther
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Rodríguez Artalejo, Fernando
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Banegas Banegas, José Ramón
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