The velocity of home blood pressure reduction in response to low-dose eplerenone combined with other antihypertensive drugs determined by exponential decay function analysis

Background/objective: Eplerenone is a highly selective aldosterone blocker, which has the potential to lower blood pressure (BP) in patients with hypertension. The objective of this study was to assess the hypotensive effects of low-dose eplerenone (25?mg) using home BP measurements. We also assessed the time required to reach 95% of the maximum antihypertensive effect (stabilization time) by analyzing exponential decay functions using home BP measurements.

Methods: We reviewed the medical records of 83 hypertensive patients who were taking eplerenone 25?mg (age, 68.6?±?11.8?years; men, 36.1%) in addition to other antihypertensive agents. Home BPs were averaged in each patient for the last 5?days of each observation period. The morning versus evening effect (M/E ratio) and the evening versus morning effect (E/M ratio) were calculated to assess the duration of action of eplerenone.

Results: The mean home systolic/diastolic BPs at baseline were 136.8?±?8.8/77.2?±?9.3?mmHg, respectively. After 8?weeks of treatment with eplerenone, home systolic/diastolic BP significantly decreased by ?7.1?±?10.1/?2.6?±?5.0?mmHg (p?p?=?0.006) and 16.5 days (p?=?0.001), respectively. When eplerenone was administered in the morning, the M/E ratio was 1.1?±?0.3. The corresponding E/M ratio for evening administration was 0.9?±?0.6. Although no nocturia was observed, there was a slight but significant increase in serum potassium levels (p?=?0.03).

Conclusions: Our data suggest that the combination of eplerenone with other antihypertensive drugs may be a promising therapeutic strategy for the treatment of essential hypertension.     

Prevalence of Masked Hypertension in Subjects Treated with Antihypertensive Drugs as Assessed by Morning versus Evening Home Blood Pressure Measurements: the J-HOME study

To investigate the relationship between morning and evening home blood pressure (BP) measurements to make a diagnosis of masked hypertension, we collected information on the characteristics of 3,303 essential hypertensive outpatients receiving antihypertensive medication in Japan using a physician, self-administered questionnaire. All patients were asked to measure their home BP once every morning and once every evening for two weeks. Morning and evening home BP values of each patient were defined as the average of all morning and all evening home BP values, respectively. The mean BP values of all study subjects were 142.8/80.6 mmHg for office BP, 139.8/81.8 mmHg for morning home BP, 133.7/76.9 mmHg for evening home BP, and 136.8/79.3 mmHg for the average of the morning and evening home BPs. Masked hypertension was defined as an office BP < 140/90 mmHg and a home BP > or = 135/85 mmHg. The prevalence of masked hypertension diagnosed using morning home BP (23.1%) was higher than that diagnosed by evening home BP (14.7%); the prevalence was 19.0% when diagnosed using the average of the morning and evening home BPs. Among the 1,386 patients with a normal office BP, the diagnosis of masked hypertension based on morning and evening home BP values differed in 28.8% of patients for systolic BP and 20.9% for diastolic BP (kappa coefficient = 0.43). The present study showed that the prevalence of masked hypertension was underestimated when the diagnosis of masked hypertension was made on the basis of evening home BP.     

Prevalence of Masked Hypertension in Subjects Treated with Antihypertensive Drugs as Assessed by Morning versus Evening Home Blood Pressure Measurements: The J-HOME Study

To investigate the relationship between morning and evening home blood pressure (BP) measurements to make a diagnosis of masked hypertension, we collected information on the characteristics of 3,303 essential hypertensive outpatients receiving antihypertensive medication in Japan using a physician, self-administered questionnaire. All patients were asked to measure their home BP once every morning and once every evening for two weeks. Morning and evening home BP values of each patient were defined as the average of all morning and all evening home BP values, respectively. The mean BP values of all study subjects were 142.8/80.6 mmHg for office BP, 139.8/81.8 mmHg for morning home BP, 133.7/76.9 mmHg for evening home BP, and 136.8/79.3 mmHg for the average of the morning and evening home BPs. Masked hypertension was defined as an office BP < 140/90 mmHg and a home BP ≥ 135/85 mmHg. The prevalence of masked hypertension diagnosed using morning home BP (23.1%) was higher than that diagnosed by evening home BP (14.7%); the prevalence was 19.0% when diagnosed using the average of the morning and evening home BPs. Among the 1,386 patients with a normal office BP, the diagnosis of masked hypertension based on morning and evening home BP values differed in 28.8% of patients for systolic BP and 20.9% for diastolic BP (kappa coefficient = 0.43). The present study showed that the prevalence of masked hypertension was underestimated when the diagnosis of masked hypertension was made on the basis of evening home BP.     

Significance of mean blood pressure for blood pressure control

The significance of pulse pressure (PP) and mean blood pressure (MBP) for blood pressure (BP) control is unclear. The aim of this study was to examine the relationship between PP and MBP and BP control. We obtained home BP measurements for 117 patients aged 40-75 years with either office systolic BP (SBP) >or= 140 mmHg or office diastolic BP (DBP) >or= 90 mmHg. Patients were treated with 1 to 2 antihypertensive drugs for 6 months to achieve home SBP < 135 mmHg and home DBP < 85 mmHg. At follow-up, 72 patients were taking a single drug with good BP control, 23 were taking two drugs with good BP control, and 22 were taking two drugs without good BP control. Although office SBP and DBP at baseline were similar in the three groups, home SBP and DBP at baseline in the single drug group were lowest among the three groups (P < 0.01). Home MBP at baseline in the single drug group was lowest among the three groups (P < 0.01). Home PP at baseline was highest in the two-drug without good control group (P < 0.001). In multivariate logistic regression analysis, only home MBP at baseline was significantly correlated with a lack of BP control. Home MBP rather than home PP is associated with achieving adequate BP control.     

Systolic vs diastolic blood pressure control in the hypertensive patients of the PAMELA population. Pressioni Arteriose Monitorate E Loro Associazioni

BACKGROUND: Previous studies have shown that in the treated fraction of the hypertensive population, blood pressure (BP) control is less common for systolic BP (SBP) than for diastolic BP (DBP) as measured in the physician's office. Whether this phenomenon is artifactually attributable to a temporary increase in BP owing to a "white-coat" effect or represents a true rarity of SBP control in daily life is unknown. METHODS: Data were obtained from the PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) study population, which involved individuals ranging in age from 25 to 74 years who were representative of the residents of Monza (a city near Milan, Italy) and who were stratified according to sex. Office (an average of 3 sphygmomanometric measurements), home (an average of morning and evening self-measurements using a semiautomatic device), and 24-hour ambulatory (average of measurements performed every 20 minutes during the day and at night) BP values were obtained in all study subjects. In the treated hypertensive patients, BP was regarded as controlled if office values were less than 140 (SBP) or 90 (DBP) mm Hg. Home and 24-hour average SBP and DBP were regarded as controlled if the values were lower than 132/83 and 125/79 mm Hg, respectively. RESULTS: In the study participants (n = 2051), the number of patients with hypertension who were receiving antihypertensive treatment was 398, or approximately 42% of all individuals with hypertension. In-office SBP control by treatment was less frequent than DBP control (29.9% vs 41.5%, P<.05). This was also the case when home and 24-hour SBP and DBP control was considered (38.3% vs 54.6% and 50.8 vs 64.9%, respectively, P<.05 for both). CONCLUSIONS: In the PAMELA population, SBP control by treatment was much less frequent than DBP control by treatment. This was the case not only for office BP values but also for home and 24-hour BP values, demonstrating that inadequate SBP control is not limited to artificial BP-measuring methods but occurs in daily life.     

Meal-induced blood pressure fall in patients with isolated morning hypertension

Abstract

We aimed to determine a possible association between isolated morning hypertension (IMH) and meal-induced blood pressure (BP) fall in adult treated hypertensive patients who underwent home BP measurements. A total of 230 patients were included, median age 73.6, 65.2% women. After adjusting for age, sex, number of antihypertensive drugs, office and home BP levels, the association between IMH and meal-induced BP fall was statistically significant. In conclusion, meal-induced BP fall and IMH detected through home blood pressure monitoring (HBPM) are independently associated in hypertensive patients. The therapeutic implications of such observation need to be clarified in large-scale prospective studies.     

Determination of the blood pressure level in mild hypertension. Significance of 20 minute resting blood pressure measurement comparing to 24 hour ambulatory blood pressure monitoring

Determination of the blood pressure (BP) level in patients with mild hypertension (MHT) is quite difficult, since ulcerations of BP are tremendously exaggerated in the doctor's office. It has been well known that casual BP is less reliable to estimate LVH than BPs obtained at home or work-site. Although 24 hour ambulatory BP monitoring (ABPM) has been widely accepted to overcome this problems, it is still controversial whether this method is applicable to all hypertensive subjects with special regards to its cost and effect. Therefore, our study has dealt mainly with the development of more convenient and less expensive method to get reasonable BPs. Twenty two nonmedicated patients with MHT were selected for the study. After taking casual BP in the office, the resting 20 minute BP measurements at every 2 minute interval were performed with Dynamap 950. Ten BP values thus obtained were divided into two categorical phases; early and late. The mean systolic and diastolic pressures (Ps & Pd) in the early phase were significantly higher than those in the late phase. Beside mean Ps and Pd obtained from 24 hour ABPM, 4 categorical phases based on the time of a day were defined; morning (from awaking to noon), afternoon (from noon to 6 pm), evening (from 6 pm to bed time) and night (during sleeping). Mutual correlation coefficients of these categorical BPs were calculated and compared to identify reasonably high significant correlations. The results revealed the highest BP at the office and the lowest one during sleeping. The office BPs closely resembled to the ones during afternoon period.(ABSTRACT TRUNCATED AT 250 WORDS)     

Relation of pulsatility of brachial artery pressure to resistant hypertension.

Few studies have examined predictors of resistant hypertension. The aim of this study was to observe the relationship between resistant hypertension and the pulsatility of the brachial artery pressure, which is characterized as pulse pressure/diastolic pressure (PP/DP) and is a simple index of aortic input impedance. We obtained home blood pressure (BP) measurements for 102 patients aged 40-75 years with either office systolic BP (SBP) > or =140 mmHg or office diastolic BP (DBP) > or =90 mmHg. Patients were given a single antihypertensive agent or left untreated during the 2-week baseline period. Thereafter, patients were treated with 1 to 3 antihypertensive drugs for 1 year with a goal of achieving a home BP of less than 135/85 mmHg. At follow-up, 72 patients were taking a single drug with good BP control, 21 were taking two drugs with good BP control, and 9 were taking three drugs with poor BP control. Although office SBP at baseline was similar among the three groups, home morning and evening SBP at baseline in the single drug group were lower than those of the two- or three-drug groups (p <0.01). Although office PP/DP at baseline did not differ among the three groups, home morning and evening PP/DP at baseline were highest in the three-drug group (p <0.01). In multivariate analysis, only mean home PP/DP at baseline was correlated with BP control. There is a correlation between the pulsatility of the brachial artery pressure and the degree of BP control.     

Comparative study of home and office blood pressure in hypertensive patients treated with enalapril/HCTZ 20/6 mg: the ESPADA study

The introduction and generalization of 24-h ambulatory blood pressure (BP) monitoring has shown the clinical relevance of home BP. The aim of this study was to assess the validity of home-measured BP for monitoring and controlling patients with arterial hypertension while on a homogeneous treatment. An additional objective was to establish the degree of office BP control obtained. This was a prospective, longitudinal, observational and multicenter study in a cohort of 156 patients of both sexes, aged over 18 years and with essential hypertension. All of them received the fixed combination enalapril/HCTZ 20/6 mg as the only hypertensive agent for at least 4 weeks previously. Office BP was the average of three measurements. For home BP, a semi-automated device (OMRON HEM 705 CP) was used. The patients measured their BP twice a day for 2 consecutive days. The average differences between the two measuring methods were low, but significant: 3.99 mmHg for systolic BP (SBP; p < 0.05), 2.02 mmHg for diastolic BP (DBP; p < 0.05). Pearson's regression coefficient between the office and home values was highly significant (p < 0.0001) for SBP, DBP and heart rate. Home BP measurement was highly reproducible as shown by the high within-class correlation coefficient for individual measurements on the first day compared with the second: 0.88 (95% confidence interval, CI 0.82-0.92; p < 0.00001) for SBP and 0.89 for DBP (95% CI 0.83-0.93; p < 0.00001). The percentage of patients with strict office DBP and SBP control (< 140/90 mmHg) was 61.3% and with DBP control (<90 mmHg) 92%. In conclusion, in the ESPADA study, the application of home BP measurement is valid, reproducible and shows a high correlation with office BP.     

What is the value of home blood pressure measurement in patients with mild hypertension?

To investigate the value of home blood pressure (BP) measurements, the BP was recorded daily by the patient at home and compared with recordings in the physician's office and with a 24-hour BP recording taken with a noninvasive ambulatory BP recorder in a group of 93 patients with mild untreated hypertension. Office BPs (mean 148/94 mm Hg) were higher than either home (138/89 mm Hg) or average 24-hour BPs (131/89 mm Hg). For systolic BP, home and office measurements gave similar correlations with 24-hour BP (0.67 and 0.55). For diastolic BP, however, home readings were lower and more accurate (0.76 vs 0.36). Thus, our findings indicate that home readings reflect the overall level of BP more reliably than office readings, and if due consideration is given to the fact that they are usually lower than office readings, they may be used as an alternative and cost-effective means of evaluating patients with mild hypertension.     

Daytime, home and office blood pressures in treated hypertensive patients according to accretion of cardiovascular risk

The relative accuracy of office, home and ambulatory blood pressure (BP) measurements has not been established in patients with metabolic syndrome (MS+). We set out to compare BP values obtained using different measurement modalities and their relationship to MS intensity in hypertensive outpatients. Office, ambulatory and home BPs and risk profile were ascertained. MS was defined according to ATPIII criteria. The study included a cohort of 104 men and 132 women with a mean age of 51.8 +/- 14.2 years; 40.3% had metabolic syndrome (MS+). The MS+ patients had higher home SBP (150 vs 142 mmHg, p < 0.01), were treated with more drugs (3.9 vs 3.0, p < 0.001) and had a poorer BP control on home measurements (11.6 vs 24.8%, p = 0.01). However, the clinical BP control rates were overall higher, and did not differ between two groups when daytime ambulatory (34.7 vs 27%) or office (26.7 vs 22.3%) values were employed. The deviation of home measurements was associated in a dose-dependent fashion with intensity of MS. Thus, in MS+ patients, the well standardized measurement protocols and equipment should be used to assess the antihypertensive efficacy. This is especially true for patients with high body mass index.     

Role of home blood pressure monitoring in overcoming therapeutic inertia and improving hypertension control: a systematic review and meta-analysis

Hypertension remains the most common modifiable cardiovascular risk factor, yet hypertension control rates remain dismal. Home blood pressure (BP) monitoring has the potential to improve hypertension control. The purpose of this review was to quantify both the magnitude and mechanisms of benefit of home BP monitoring on BP reduction. Using a structured review, studies were selected if they reported either changes in BP or percentage of participants achieving a pre-established BP goal between randomized groups using home-based and office-based BP measurements. A random-effects model was used to estimate the magnitude of benefit and relative risk. The search yielded 37 randomized controlled trials with 9446 participants that contributed data for this meta-analysis. Compared with clinic-based measurements (control group), systolic BP improved with home-based BP monitoring (-2.63 mm Hg; 95% CI, -4.24, -1.02); diastolic BP also showed improvement (-1.68 mm Hg; 95% CI, -2.58, -0.79). Reductions in home BP monitoring-based therapy were greater when telemonitoring was used. Home BP monitoring led to more frequent antihypertensive medication reductions (relative risk, 2.02 [95% CI, 1.32 to 3.11]) and was associated with less therapeutic inertia defined as unchanged medication despite elevated BP (relative risk for unchanged medication, 0.82 [95% CI, 0.68 to 0.99]). Compared with clinic BP monitoring alone, home BP monitoring has the potential to overcome therapeutic inertia and lead to a small but significant reduction in systolic and diastolic BP. Hypertension control with home BP monitoring can be enhanced further when accompanied by plans to monitor and treat elevated BP such as through telemonitoring.     

Multiple clinic and home blood pressure measurements versus ambulatory blood pressure monitoring.

To compare multiple clinic and home blood pressure (BP) measurements and ambulatory BP monitoring in the clinical evaluation of hypertension, we studied 239 middle-aged pharmacologically untreated hypertensive men and women who were referred to the study from the primary healthcare provider. Ambulatory BP monitoring was successfully completed for 233 patients. Clinic BP was measured by a trained nurse with a mercury sphygmomanometer and averaged over 4 duplicate measures. Self-recorded home BP was measured with a semiautomatic oscillometric device twice every morning and twice every evening on 7 consecutive days. Ambulatory BP was recorded with an auscultatory device. Two-dimensionally controlled M-mode echocardiography was successfully performed on 232 patients. Twenty-four-hour urinary albumin was determined by nephelometry. Clinic BP was 144.5+/-12.6/94.5+/-7.4 mm Hg, home BP (the mean of 14 self-recorded measures) was 138.9+/-13.1/92.9+/-8.6 mm Hg, home morning BP (the mean of the first 4 duplicate morning measures) was 137.1+/-13.7/92.4+/-9.2 mm Hg, daytime ambulatory BP was 148.3+/-13. 9/91.9+/-7.8 mm Hg, nighttime ambulatory BP was 125.5+/-16.4/75. 6+/-8.9 mm Hg, and 24-hour ambulatory BP was 141.7+/-14.0/87.2+/-7.6 mm Hg. Pearson correlation coefficients of clinic, home, home morning, and daytime ambulatory BPs to albuminuria and to the characteristics of the left ventricle were nearly equal. In multivariate regression analyses, 36% (P<0.0001) of the cross-sectional variation in left ventricular mass index was attributed to gender and home morning systolic BP in models that originally included age, gender, and clinic, self-measured home morning, and ambulatory daytime, nighttime, and 24-hour systolic and diastolic BPs. We concluded that carefully controlled nonphysician-measured clinic and self-measured home BPs, when averaged over 4 duplicate measurements, are as reliable as ambulatory BP monitoring in the clinical evaluation of untreated hypertension.     

Lack of adequate blood pressure control in the morning and evening periods in medicated hypertensive patients considered to be controlled in the office.

BACKGROUND AND AIM: In hypertensive patients tight blood pressure (BP) control during the critical morning and evening periods may be relevant for preventing cardiovascular events, which most frequently occur at these times of the day. METHODS: In a prospective study we evaluated 24h ambulatory BP (ABP) values (24h, daytime, nighttime, morning period between 6-10 am and evening period between 6-10 pm), in 103 hypertensive patients (HTs), aged between 18-79 years, considered to be controlled in the office in the previous two months (office BP < 140/90 mmHg, 2 x 3 readings, before taking medication), who were being treated with antihypertensive drugs taken once daily in the morning. Based on ABP data, HTs were considered to have good BP control if daytime BP values were < 135/85 mmHg, < 133.1/85.4 mmHg during the morning period, and < 138.1/89.3 mmHg during the evening period. Otherwise control of ABP was considered poor. These limits correspond to the upper 95% confidence limits of BP calculated for each period in a normotensive control population of 210 subjects age-matched to the HTs. RESULTS: Of the 103 HTs, 39 were under monotherapy and the remaining 64 on combination regimens (34 with two drugs, 29 with three and one with four). Based on ABP data of the 103 HTs, poor ABP control was observed in 36 (35%) in the morning period, in 24 (23%) in the evening period and in 29 (28%) for daytime BP values. ABP values during both the morning and evening periods correlated significantly with daytime values (r = 0.72 and r = 0.89 respectively, p < 0.01) but not with office values. CONCLUSIONS: A significant proportion of treated HTs who are considered to be controlled in the office present abnormally high ABP levels, particularly in the critical early morning period, but also during the evening and throughout the daytime period.     

Control of home heart rate and home blood pressure levels in treated patients with hypertension: the J-HOME study

OBJECTIVE: Recently, it was found that resting heart rate (HR) measured at home (home HR), as well as self-measured blood pressure (BP) at home (home BP), was a strong predictor of the risk of cardiovascular disease mortality in the general Japanese population. It was also reported that home BP levels were not adequately controlled in hypertensive patients. Little information, however, is available on the current status of home HR control in treated patients with hypertension. The objective of this study was to examine the current status of home HR control and home BP control among treated patients with hypertension. METHODS: Home HR and BP were measured using a self-monitored BP measuring device. Morning home HR and BP were obtained in 3183 patients and evening home HR and BP were obtained in 3106 patients. On the basis of an earlier study, we defined a home HR value of >or=70 beats/min as 'high home HR'. RESULTS: The mean home HR value was 67.2+/-9.1 beats/min in the morning and 69.6+/-9.2 beats/min in the evening. Of the 3183 patients, 35.7% had a high home HR in the morning and 46.7% of the 3106 patients had a high home HR in the evening. The prevalence of patients with a high home HR and a controlled home BP (<135/85 mmHg) was 11.3% in the morning and 24.2% in the evening. CONCLUSION: Resting home HR control and home BP control were inadequate.     

Optimal schedule for home blood pressure measurement based on prognostic data: the Finn-Home Study

Current guidelines based on cross-sectional statistical parameters derived from reference populations make equivocal recommendations for the optimal schedule of home blood pressure (BP) measurement. The objective of this study was to determine a schedule for home BP measurements in relation to their predictive value for total cardiovascular risk. Home BP was measured twice every morning and evening for 1 week in an unselected nationwide population of 2081 subjects aged 45 to 74 years. The prognostic significance of BP for fatal and nonfatal cardiovascular events was examined using adjusted Cox proportional hazards regression models. A total of 162 cardiovascular events were recorded during a 6.8-year follow-up. The predictive value of home BP increased progressively with the number of measurements, showing the highest predictive value with the average of all measurements (systolic/diastolic hazard ratio per 1-mm Hg increase in BP: 1.021/1.034; systolic/ diastolic 95% CI: 1.012 to 1.030/1.018 to 1.049). However, most of this increase was achieved during the first 3 days of measurement (hazard ratio: 1.017/1.028; 95% CI: 1.009 to 1.026/1.013 to 1.045), and only minimal increase occurred after day 6. No additional benefit was achieved by discarding the values obtained during the first day of measurement. Morning and evening BPs were equally predictive of future cardiovascular events. Novel prognostic data from this study show that measurement of home BP twice in the morning and evening, preferably for a period of 7 days, or for at least 3 days, provides a thorough image of a patient's BP level. This information should be used to prepare a unified international guideline for home BP measurement.     

Reproducibility of masked uncontrolled hypertension detected through home blood pressure monitoring

Masked uncontrolled hypertension (MUCH) is an entity described in treated hypertensive subjects, where office blood pressure (BP) is well controlled and out‐of‐office BP is elevated. It has been related to a higher cardiovascular risk. However, the reproducibility of MUCH has been scarcely studied. In this study, we aimed to determine the reproducibility of MUCH detected through home blood pressure monitoring (HBPM). Two sets of measurements were performed in hypertensive adults under stable treatment with a 1‐week interval. Each set of measurements included three office BP readings and a 4‐day HBPM with duplicate readings in the morning, afternoon, and evening (the same validated oscillometric device was employed in both settings). We determined the percentage of agreement regarding the presence of MUCH in the two sets of measurements and quantified such agreement through the Cohen's kappa coefficient (κ), its 95% confidence interval, and P value. We included 105 patients (median age 58.6 [IQR 45.6‐67.2] years old, 53.4% men). MUCH prevalence on at least one occasion was 22.3% (95% CI: 15.2‐31.5). The reproducibility of MUCH was scant: κ = 0.19 (95% CI: 0.0002‐0.38), P = 0.02, due to the poor reproducibility of the office BP component of MUCH in comparison with the home BP component: κ = 0.21 (95% CI: 0.03‐0.39), P = 0.01 vs κ = 0.48 (95% CI 0.29‐0.67), P < 0.001, respectively. In conclusion, the reproducibility of MUCH detected through HBPM is minimal, mainly due to the poor reproducibility of office BP measurements. An HBPM‐based strategy for the management of patients with MUCH may be more adequate in terms of cardiovascular morbidity and mortality.     

Prevalence of masked uncontrolled and treated white-coat hypertension defined according to the average of morning and evening home blood pressure value: from the Japan Home versus Office Measurement Evaluation Study

OBJECTIVE: To evaluate the prevalence of masked uncontrolled and treated white-coat hypertension defined according to the average of morning and evening home blood pressure values. METHODS: The study population consisted of 3303 essential hypertensive outpatients receiving antihypertensive treatment in Japan. Information on the characteristics of the patients was collected by a physician's self-administrated questionnaire. The office blood pressure value was calculated as the average of the four readings in two visits. All patients were asked to measure their blood pressure once every morning and once every evening. In the study, we included patients with at least three measurements in the morning and in the evening, respectively. The average of all home blood pressure values was taken as the home blood pressure value. RESULTS: The mean value of home systolic/diastolic blood pressure was 136.8/79.3 mmHg, and the mean value of office systolic/diastolic blood pressure was 142.8/80.6 mmHg. Of the 3303 patients, 758 (23.0%) had controlled hypertension (home <135/85 mmHg and office <140/90 mmHg), 628 (19.0%) had masked uncontrolled hypertension (home > or =135/85 mmHg and office <140/90 mmHg), 640 (19.4%) had treated white-coat hypertension (home <135/85 mmHg and office > or =140/90 mmHg), and 1277 (38.7%) had uncontrolled hypertension (home > or =135/85 mmHg and office > or =140/90 mmHg). CONCLUSIONS: Treated white-coat hypertension and masked uncontrolled hypertension were often observed in clinical settings. Physicians need to understand the prevalence of such patients to prevent inadequate diagnosis and treatment in them.