Cited by 157Blood Pressure and Hypertension StudiesCardiovascular Health and Disease PreventionSodium Intake and Health

Setting Thresholds to Varying Blood Pressure Monitoring Intervals Differentially Affects Risk Estimates Associated With White-Coat and Masked Hypertension in the Population

Open access
Asayama, Kei, Thijs, Lutgarde, Li, Yan, Gu, Yu-Mei, Hara, Azusa, Liu, Yan-Ping, Zhang, Zhenyu, Wei, Fang-Fei +25 more·2014·Hypertension

Abstract

Outcome-driven recommendations about time intervals during which ambulatory blood pressure should be measured to diagnose white-coat or masked hypertension are lacking. We cross-classified 8237 untreated participants (mean age, 50.7 years; 48.4% women) enrolled in 12 population studies, using ≥140/≥90, ≥130/≥80, ≥135/≥85, and ≥120/≥70 mm Hg as hypertension thresholds for conventional, 24-hour, daytime, and nighttime blood pressure. White-coat hypertension was hypertension on conventional measurement with ambulatory normotension, the opposite condition being masked hypertension. Intervals used for classification of participants were daytime, nighttime, and 24 hours, first considered separately, and next combined as 24 hours plus daytime or plus nighttime, or plus both. Depending on time intervals chosen, white-coat and masked hypertension frequencies ranged from 6.3% to 12.5% and from 9.7% to 19.6%, respectively. During 91 046 person-years, 729 participants experienced a cardiovascular event. In multivariable analyses with normotension during all intervals of the day as reference, hazard ratios associated with white-coat hypertension progressively weakened considering daytime only (1.38; P =0.033), nighttime only (1.43; P =0.0074), 24 hours only (1.21; P =0.20), 24 hours plus daytime (1.24; P =0.18), 24 hours plus nighttime (1.15; P =0.39), and 24 hours plus daytime and nighttime (1.16; P =0.41). The hazard ratios comparing masked hypertension with normotension were all significant ( P <0.0001), ranging from 1.76 to 2.03. In conclusion, identification of truly low-risk white-coat hypertension requires setting thresholds simultaneously to 24 hours, daytime, and nighttime blood pressure. Although any time interval suffices to diagnose masked hypertension, as proposed in current guidelines, full 24-hour recordings remain standard in clinical practice.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1161/hypertensionaha.114.03614

Cites

47 of 47 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • About 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 [27]

    The Results section (page unavailable) reports white-coat hypertension in 6.3%–12.5% of the study population, depending on the definition used. That supports its occurrence, but those percentages are for all participants, not specifically clinic attendees with high blood pressure; the paper does not establish the claimed 10%–30% range for that group. (LLM, conf=0.84)

    Experimental — accuracy not yet measured
  • About 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 [27]

    The Results (Prevalence of White-Coat, Masked, and Sustained Hypertension; page unavailable) report masked hypertension in 9.7% of participants using 24-hour blood pressure, with estimates ranging from 9.7% to 19.6% under different definitions. But the Methods (Study Population; page unavailable) describe randomly recruited population cohorts, not subjects attending clinics because of high blood pressure. The claimed clinic population is therefore not supported. (LLM, conf=0.87)

    Experimental — accuracy not yet measured
  • The 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 [27]

    The Abstract and Methods define white-coat hypertension as elevated office blood pressure with normal ambulatory blood pressure, and masked hypertension as the reverse. The Discussion also mentions home monitoring for masked hypertension, but our copy does not establish home measurements as a way to identify white-coat hypertension; that part of the citing sentence goes beyond this source. (LLM, conf=0.82)

    Experimental — accuracy not yet measured
  • Out-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 [27]

    The Results section, “Risk of a Cardiovascular Event Associated With Masked Hypertension” (page unavailable), finds elevated cardiovascular-event risk in people whose ambulatory blood pressure is high despite normal office blood pressure. This supports the value of out-of-office measurement for identifying cardiovascular risk, but the paper does not assess hypertension-induced organ damage or establish the claim’s general comparison that out-of-office measurements are more closely associated with both outcomes than office measurements. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • 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 [27]

    The Results (Risk of a Cardiovascular Event Associated With White-Coat Hypertension; page unavailable) place white-coat hypertension between normotension and sustained hypertension in the reported hazard-ratio trend, and find its risk consistently lower than sustained hypertension. But its excess risk over normotension was not statistically significant under several ambulatory-blood-pressure definitions, so the unqualified claim overstates the finding. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Authors
Asayama, K., Thijs, L., Li, Y., Gu, Y.-M., Hara, A., Liu, Y.-P., Zhang, Z., Wei, F.-F., Lujambio, I., Mena, L. J., Boggia, J., Hansen, T. W., Björklund-Bodegård, K., Nomura, K., Ohkubo, T., Jeppesen, J., Torp-Pedersen, C., Dolan, E., Stolarz-Skrzypek, K., Malyutina, S., Casiglia, E., Nikitin, Y., Lind, L., Luzardo, L., Kawecka-Jaszcz, K., Sandoya, E., Filipovský, J., Maestre, G. E., Wang, J., Imai, Y., Franklin, S. S., O’Brien, E., & Staessen, J. A.
Affiliations
  • Tohoku University (JP)
  • Shanghai Jiao Tong University (CN)
  • From the Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium (K.A., L.T., Y.-M.G., A.H., Y.-P.L., Z.Z., F.-F.W., 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.); Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations,...
  • Universidad del Zulia (VE)
  • University College Dublin (IE)
Venue
Hypertension
Published
2014-11
Volume
64
Issue
5
Pages
935-942
ISSN
  • 0194-911X (ISSN-L)
  • 1524-4563
OpenAlex
W2099637441
Cited by
157
References
47
Citations by year
2026: 4 · 2025: 3 · 2024: 8 · 2023: 16 · 2022: 18 · 2021: 11 · 2020: 21 · 2019: 24 · 2018: 22 · 2017: 19 · 2016: 7 · 2015: 4
FWCI
6.86
Type
journal article
Language
en
Open access
Locations
  • Hypertension (publishedVersion)
  • PubMed (publishedVersion)
  • VBN Forskningsportal (Aalborg Universitet) (publishedVersion, other-oa)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • ScholarWorks @ UTRGV (The University of Texas Rio Grande Valley) (submittedVersion)
  • Lirias (submittedVersion, other-oa)
  • Homo Politicus (Academy of Humanities and Economics in Lodz) (submittedVersion)
  • Jagiellonian University Repository (Jagiellonian University) (submittedVersion, cc-by-nc-nd)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
  • Institutional Repositories DataBase (IRDB) (submittedVersion, cc-by-nc-nd)
  • Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
  • Padua Research Archive (University of Padova) (submittedVersion)
Funders
  • Univerzita Karlova v Praze
  • Hjerteforeningen
  • European Commission (305507)
  • National Natural Science Foundation of China (81170245, 30871081, 81270373)
  • Daiwa Securities Health Foundation
  • Universidad de la República Uruguay
  • Fondo Nacional de Ciencia Tecnología e Innovación
  • Vlaamse regering
  • H. Lundbeck A/S
  • Japan Society for the Promotion of Science (25253059)
  • Comisión Sectorial de Investigación Científica
  • National Institute on Aging (R01AG036469, 1-R01AG036469 A1)
  • Fogarty International Center
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, ambulatory blood pressure monitoring, blood pressure thresholds, hypertension diagnosis, cardiovascular risk, 24-hour ambulatory blood pressure, untreated hypertensive patients
MeSH terms
Adult, Aged, Blood Pressure, Cardiovascular Diseases, Circadian Rhythm, Female, Humans, Male, Middle Aged, Risk Factors, Time Factors, Prevalence, Multivariate Analysis, Practice Guidelines as Topic, Blood Pressure Monitoring, Ambulatory, White Coat Hypertension, Masked Hypertension

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review