期刊
HYPERTENSION
卷 59, 期 3, 页码 564-U96出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/HYPERTENSIONAHA.111.180653
关键词
isolated systolic hypertension; ambulatory blood pressure; white-coat hypertension; white-coat effect; cardiovascular disease; epidemiology
资金
- European Union [IC15-CT98-0329-EPOGH, LSHM-CT-2006-037093, HEALTH-F4-2007-201550, HEALTH-F7-2011-278249 EU-MASCARA]
- European Research Council [294713 EPLORE]
- Fonds voor Wetenschappelijk Onderzoek Vlaanderen (Ministry of the Flemish Community, Brussels, Belgium) [G.0575.06, G.0734.09]
- Katholieke Universiteit Leuven [OT/00/25, OT/05/49]
- research groups in Shanghai
- research groups in Krakow
- research groups in Padova
- research groups in Novosibirsk
- Ministry of the Flemish Community, Brussels [BIL02/10]
- Y.L. in Leuven
- Danish Heart Foundation [01-2-9-9A-22914]
- Lundbeck Fonden [R32-A2740]
- Ministry of Education, Culture, Sports, Science, and Technology [15790293, 16590433, 17790381, 18390192, 18590587, 19590929, 19790423]
- Ministry of Health, Labor, and Welfare [H17-Kenkou-007, H18-Junkankitou[Seishuu]-Ippan-012, H20-Junkankitou[Seishuu]-Ippan-009, H20-Junkankitou[Seishuu]-Ippan-013]
- Japanese Society for the Promotion of Science [16.54041, 18.54042, 19.7152, 20.7198, 20.7477, 20.54043]
- Japan Atherosclerosis Prevention Fund
- Uehara Memorial Foundation
- Takeda Medical Research Foundation
- National Cardiovascular Research Grants
- Biomedical Innovation Grants in Japan
- National Natural Science Foundation of China, Beijing, China [30871360, 30871081]
- Shanghai Commission of Science and Technology [07JC14047, 06QA14043]
- Shanghai Commission of Education
The significance of white-coat hypertension in older persons with isolated systolic hypertension remains poorly understood. We analyzed subjects from the population-based 11-country International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes database who had daytime ambulatory blood pressure (BP; ABP) and conventional BP (CBP) measurements. After excluding persons with diastolic hypertension by CBP (>= 90 mm Hg) or by daytime ABP (>= 85 mm Hg), a history of cardiovascular disease, and persons<18 years of age, the present analysis totaled 7295 persons, of whom 1593 had isolated systolic hypertension. During a median follow-up of 10.6 years, there was a total of 655 fatal and nonfatal cardiovascular events. The analyses were stratified by treatment status. In untreated subjects, those with white-coat hypertension (CBP >= 140/<90 mm Hg and ABP<135/<85 mm Hg) and subjects with normal BP (CBP<140/<90 mm Hg and ABP<135/<85 mm Hg) were at similar risk (adjusted hazard rate: 1.17 [95% CI: 0.87-1.57]; P=0.29). Furthermore, in treated subjects with isolated systolic hypertension, the cardiovascular risk was similar in elevated conventional and normal daytime systolic BP as compared with those with normal conventional and normal daytime BPs (adjusted hazard rate: 1.10 [95% CI: 0.79-1.53]; P = 0.57). However, both treated isolated systolic hypertension subjects with white-coat hypertension (adjusted hazard rate: 2.00; [95% CI: 1.43-2.79]; P<0.0001) and treated subjects with normal BP (adjusted hazard rate: 1.98 [95% CI: 1.49-2.62]; P<0.0001) were at higher risk as compared with untreated normotensive subjects. In conclusion, subjects with sustained hypertension who have their ABP normalized on antihypertensive therapy but with residual white-coat effect by CBP measurement have an entity that we have termed, treated normalized hypertension. Therefore, one should be cautious in applying the term white-coat hypertension to persons receiving antihypertensive treatment. (Hypertension. 2012; 59: 564-571.). Online Data Supplement
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