What Is the Hypertension Phenotype?

Today, the characterization of the hypertension phenotype relies essentially on the repeated measurement of blood pressure in the physician's office. Blood pressure values acquired in these conditions have been shown to correlate with the cardiovascular outcome and the risk of developing hypertension-induced target organ damages. However, the limitations of office blood pressure are now well recognized and there is increasing evidence that other components of blood pressure may help to improve the determination of the hypertensive phenotype. This starts with the monitoring of blood pressure outside the office using either 24-h ambulatory or home blood pressure monitoring. With these new diagnostic tools, new phenotypes of hypertension have been identified such as white coat hypertension and masked hypertension which carry different risks of hypertensive complications. More recently, the ability to measure central blood pressure has further questioned the pertinence of continuing to measure only office blood pressure in hypertension. There is no doubt today that these new possibilities to complete the hypertension phenotype should be sometimes introduced in clinical practice when the evidence of added value is strong. However, there is a huge need for physicians' education before these new parameters can be integrated in the daily management of hypertensive patients.