Prognosis of White-Coat and Masked Hypertension: International Database of Home Blood Pressure in Relation to Cardiovascular Outcome
Open accessAbstract
Home blood pressure monitoring is useful in detecting white-coat and masked hypertension and is recommended for patients with suspected or treated hypertension. The prognostic significance of white-coat and masked hypertension detected by home measurement was investigated in 6458 participants from 5 populations enrolled in the International Database of HOme blood pressure in relation to Cardiovascular Outcomes. During a median follow-up of 8.3 years, 714 fatal plus nonfatal cardiovascular events occurred. Among untreated subjects (n=5007), cardiovascular risk was higher in those with white-coat hypertension (adjusted hazard ratio 1.42; 95% CI [1.06–1.91]; P =0.02), masked hypertension (1.55; 95% CI [1.12–2.14]; P <0.01) and sustained hypertension (2.13; 95% CI [1.66–2.73]; P <0.0001) compared with normotensive subjects. Among treated patients (n=1451), the cardiovascular risk did not differ between those with high office and low home blood pressure (white-coat) and treated controlled subjects (low office and home blood pressure; 1.16; 95% CI [0.79–1.72]; P =0.45). However, treated subjects with masked hypertension (low office and high home blood pressure; 1.76; 95% CI [1.23–2.53]; P =0.002) and uncontrolled hypertension (high office and home blood pressure; 1.40; 95% CI [1.02–1.94]; P =0.04) had higher cardiovascular risk than treated controlled patients. In conclusion, white-coat hypertension assessed by home measurements is a cardiovascular risk factor in untreated but not in treated subjects probably because the latter receive effective treatment on the basis of their elevated office blood pressure. In contrast, masked uncontrolled hypertension is associated with increased cardiovascular risk in both untreated and treated patients, who are probably undertreated because of their low office blood pressure.
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Subjects with white coat hypertension are at intermediate cardiovascular risk between normotensives and sustained hypertensives.
“White coat hypertension: These subjects are at intermediate cardiovascular risk between normotensives and sustained hypertensives.”
From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [26]
The Results report intermediate cardiovascular risk for untreated subjects with white-coat hypertension: their hazard ratio was 1.42, versus 2.13 for sustained hypertension, with normotension as the reference. The claim omits the treatment distinction; among treated subjects, white-coat hypertension did not confer higher risk than treated normotension. (LLM, conf=0.90)
Experimental — accuracy not yet measuredOut-of-office blood pressure measurements are more closely associated with hypertension-induced organ damage and the risk of cardiovascular events than office measurements.
“more closely associated with hypertension-induced organ damage and the risk of cardiovascular events”
From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [26]
The Abstract and Cardiovascular Event Rate section report that home blood pressure identifies cardiovascular risk missed by office measurements, particularly in treated patients with masked hypertension. They do not establish the broader comparison for all out-of-office measurements, and the copy does not assess hypertension-induced organ damage (section passages have no page numbers). (LLM, conf=0.83)
Experimental — accuracy not yet measuredAbout 10% to 30% of subjects attending clinics due to high blood pressure have white coat hypertension.
“About 10%-30% of subjects attending clinics due to high BP have white coat hypertension”
From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [26]
The Results section (page unavailable) reports white-coat hypertension in 25.8% of treated subjects with elevated office blood pressure, within the claimed range, but in 42.9% of untreated subjects with elevated office blood pressure. The Prevalence section reports 14.3% among all participants, not specifically people with high office blood pressure. Thus the paper does not support 10%–30% as a general estimate for the group described. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAbout 10% to 15% of subjects attending clinics due to high blood pressure have masked hypertension.
“and 10%-15% have masked hypertension.”
From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [26]
The Prevalence of White-Coat and Masked Hypertension section reports masked hypertension in 9.8% of this study’s participants and 14.6% in a comparison database, supporting the approximate 10%–15% range. But the Study Population section describes participants drawn from five population studies, not subjects attending clinics because of high blood pressure; the claim’s population qualifier is unsupported. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe use of office and out-of-office blood pressure measurements identifies individuals with white coat hypertension and those with masked hypertension.
“The use of office and out-of-office (home or ambulatory) BP measurements identifies individuals with white coat hypertension, who have elevated BP only in the office (nonelevated ambulatory or home BP), and those with masked hypertension, who have nonelevated BP in the office but elevated BP out of the office (ambulatory or home). 1,2,17-21,25-27”
From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [26]
Out-of-office blood pressure measurements identify the white coat and masked hypertension phenomena.
“and identify the white coat and masked hypertension phenomena (see below).”
From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [26]
Patients with masked hypertension are at similar risk of cardiovascular events as sustained hypertensives.
“Masked hypertension: These patients are at similar risk of cardiovascular events as sustained hypertensives.”
From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [26]
Out-of-office blood pressure measurements are more reproducible than office measurements.
“Out-of-office BP measurements (by patients at home or with 24-hour ambulatory blood pressure monitoring [ABPM]) are more reproducible than office measurements,”
From 2020 International Society of Hypertension Global Hypertension Practice Guidelines (2020) · cites this paper as [26]
The Office and Home BP Measurements section describes how readings were collected, but does not compare their reproducibility. The discussion distinguishes home from ambulatory monitoring without assessing either method’s reproducibility against office measurements. Searches for reproducibility, repeatability, variability, and reliability did not locate that comparison in our copy. (LLM, conf=0.72)
Experimental — accuracy not yet measuredMasked hypertension carries similar CVD risk to established hypertension.
“This is an important clinical finding since masked hypertension carries similar CVD risk to established hypertension [30]”
From The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance (2022) · cites this paper as [30]
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Self-citation
- Authors
- Stergiou, G. S., Asayama, K., Thijs, L., Kollias, A., Niiranen, T. J., Hozawa, A., Boggia, J., Johansson, J. K., Ohkubo, T., Tsuji, I., Jula, A. M., Imai, Y., & Staessen, J. A.
- Affiliations
- Tohoku University (JP)
- From the Hypertension Center, Third University Department of Medicine, Sotiria Hospital, Athens, Greece (G.S.S., A. K.); Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (K.A., L.T., J.A.S.); Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan (K.A., T.O., Y.I.); Population Studies Unit,...
- ORCID
- Venue
- Hypertension
- Published
- 2014-04
- Volume
- 63
- Issue
- 4
- Pages
- 675-682
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2097748162
- Cited by
- 304
- References
- 34
- Citations by year
- 2026: 14 · 2025: 18 · 2024: 11 · 2023: 19 · 2022: 26 · 2021: 9 · 2020: 44 · 2019: 32 · 2018: 25 · 2017: 24 · 2016: 36 · 2015: 29 · 2014: 17
- FWCI
- 24.23
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- Lirias (KU Leuven) (submittedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Funders
- European Commission (LSHM-CT-2006-037093, G.0881.13, 201550, 278249, 305507)
- Ministry of Education, Culture, Sports, Science and Technology (24591060, 23390171, 23790242, H21-Choju-Ippan-001, 24790654)
- Ministry of Health, Labour and Welfare
- Daiwa Securities Health Foundation
- Suomen Hammaslääkäriliitto
- Vlaamse regering
- Japan Society for the Promotion of Science (23390171, 25253059)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- white coat hypertension, masked hypertension, home blood pressure monitoring, cardiovascular risk, cardiovascular events, antihypertensive therapy, uncontrolled hypertension, untreated hypertension, office blood pressure
- MeSH terms
- Adult, Aged, Antihypertensive Agents, Blood Pressure, Cardiovascular Diseases, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prognosis, Risk Factors, Prevalence, Databases, Factual, Treatment Outcome, Blood Pressure Monitoring, Ambulatory, White Coat Hypertension, Masked Hypertension
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