Short-Term and Long-Term Reproducibility of Hypertension Phenotypes Obtained by Office and Ambulatory Blood Pressure Measurements

Abstract

The authors aimed to assess the reproducibility of normotension and white-coat, masked, and sustained hypertension in 839 untreated patients who underwent two separate assessments (median, 3; interquartile range, 0-13 months) by both office and ambulatory blood pressure (BP) monitoring (ABPM). The proportion of patients falling into the same category in the two assessments was: 52% normotension and 55% white-coat, 47% masked, and 82% sustained hypertension. The most frequent switch was to sustained hypertension (26% of white-coat and 33% of masked hypertension). No clinical factors predicted the change in category, except for higher office diastolic BP in patients with masked hypertension who developed sustained hypertension, compared with those who remained with masked hypertension (84±4 mm Hg vs 80±5 mm Hg; P=.006). The reproducibility of hypertension phenotypes was highly dependent on the time between assessments. The authors conclude that white-coat and masked hypertension phenotypes are only reproducible in the short-term, while they frequently shift towards sustained hypertension in the long-term.

Figure 1

Proportion of patients with the four hypertension phenotypes in the first and second assessments. NT indicates normotension; WCH, white‐coat hypertension; MH, masked hypertension; SH, sustained hypertension.

Figure 2

Proportion of patients with reproducible phenotypes according to time between assessments. Left: assessments separated by less than 1 month. Right: assessments separated by 1 month or more. BP indicates blood pressure; ABPM, ambulatory blood pressure monitoring; NT, normotension; WCH, white‐coat hypertension; MH, masked hypertension; SH, sustained hypertension.