Characteristics of young-onset white coat hypertension identified by targeted screening for hypertension at a university health check-up

Previously we estimated the prevalence of essential hypertension (EH) as around 0.1% and suggested that male gender, obesity, and strong genetic background (hypertension in parents) were risk factors for EH in a young population aged less than 30 based on targeted screening for hypertension at a university health check-up. This study also revealed a high incidence of white coat hypertension (WCH) in university students, and thus, we continued this screening for four consecutive years, and examined the prognosis and clinical characteristics of young-onset WCH. Three occasions of casual blood pressure (BP) measurement and additional home BP measurement revealed 72 WCH and 15 EH students (all males) during the 4-year study period. None of the WCH students had elevated home BP to the level of hypertension during their stay at university, and 26 out of 38 WCH students participating screening in the following years showed normal casual BP. Although WCH students showed a significantly higher pulse rate than controls, WCH could not be fully differentiated from EH either by pulse rate or by correlation between casual BP value and pulse rate. These findings indicate the requirement of longer follow-up after graduation to determine the prognosis of young-onset WCH, though EH and WCH in the young population share the same risk factors and, possibly, autonomic nervous system dysfunction. Since diagnosis of WCH has limited importance for university students, screening of EH following a general health check-up would elevate the clinical validity of casual BP measurement at the university.     

Investigation of major genetic polymorphisms in the Renin-Angiotensin-aldosterone system in subjects with young-onset hypertension selected by a targeted-screening system at university

Although polymorphisms in renin-angiotensin-aldosterone (RAA) system genes for angiotensinogen (AGT M235T), angiotensin-converting enzyme (ACE I/D), angiotensin II type 1 receptor (AT1 A/C1166), and aldosterone synthase (CYP11B2-344T/C) have been major targets for genetic investigation in association with essential hypertension (EH), the influence of these genetic factors is still to be determined. Because patients with young-onset EH are thought to possess a stronger genetic background than EH patients who show elevated BP relatively late in life, the targeted screening of hypertensive students in Tohoku University was completed for the selection of subjects for genetic investigation. Out of 16,434 students (12,794 males and 3,670 females) younger than 30, 22 students showed a high blood pressure (BP) (systolic and diastolic BP of 140 and/or 90 mmHg or greater, respectively, on two occasions and more than 135 and/or 85 mmHg, respectively, at a third measurement during casual BP measurements at the Tohoku University Health Center. These 22 students were asked to measure their BP at home (HBP). Six of the students had a systolic HBP of more than 135 mmHg and/or a diastolic HBP of more than 85 mmHg, and these students subsequently received medical examinations at Tohoku University Hospital and were diagnosed with EH. Genotyping for the four major genetic polymorphisms mentioned above was performed on the six students with EH and on 12 of the remaining 16 students whose HBP was within the normal range (white coat hypertension: WCH). Neither the EH nor the WCH students showed a different distribution of genotypes and allelic frequencies, compared to those found in the general Japanese population. Hence, the present study suggests that none of the major genetic polymorphisms in the RAA system strongly influence the onset of EH.     

Investigation of Major Genetic Polymorphisms in the Renin-Angiotensin-Aldosterone System in Subjects with Young-Onset Hypertension Selected by a Targeted-Screening System at University

Although polymorphisms in renin-angiotensin-aldosterone (RAA) system genes for angiotensinogen (AGT M235T), angiotensin-converting enzyme (ACE I/D), angiotensin II type 1 receptor (AT1 A/C¹¹⁶⁶), and aldosterone synthase (CYP11B2–344T/C) have been major targets for genetic investigation in association with essential hypertension (EH), the influence of these genetic factors is still to be determined. Because patients with young-onset EH are thought to possess a stronger genetic background than EH patients who show elevated BP relatively late in life, the targeted screening of hypertensive students in Tohoku University was completed for the selection of subjects for genetic investigation. Out of 16,434 students (12,794 males and 3,670 females) younger than 30, 22 students showed a high blood pressure (BP) (systolic and diastolic BP of 140 and/or 90 mmHg or greater, respectively, on two occasions and more than 135 and/or 85 mmHg, respectively, at a third measurement during casual BP measurements at the Tohoku University Health Center. These 22 students were asked to measure their BP at home (HBP). Six of the students had a systolic HBP of more than 135 mmHg and/or a diastolic HBP of more than 85 mmHg, and these students subsequently received medical examinations at Tohoku University Hospital and were diagnosed with EH. Genotyping for the four major genetic polymorphisms mentioned above was performed on the six students with EH and on 12 of the remaining 16 students whose HBP was within the normal range (white coat hypertension: WCH). Neither the EH nor the WCH students showed a different distribution of genotypes and allelic frequencies, compared to those found in the general Japanese population. Hence, the present study suggests that none of the major genetic polymorphisms in the RAA system strongly influence the onset of EH.     

Clinical characteristics of young-onset and medical treatment-requiring hypertension identified by targeted screening in university health check-up

Based on targeted screening for hypertension at a university health check-up, we previously reported a high incidence of white-coat hypertension and estimated prevalence of hypertension requiring medical treatments (HT) as around 0.1% in young population aged less than 30. In spite of such low prevalence, continuous screening for seven consecutive years (2003-2009) increased the number of HT students to 20 (19 males and 1 female). We presently assessed the clinical characteristics of these HTs. Renovascular hypertension was found in the only female HT and aortic valve regurgitation in two HTs. Resting 17 HTs were diagnosed as having essential hypertension (EH). A father and/or a mother had EH in 16 out of 17 EHs, and blood pressure (BP) at home was slightly elevated (135-145 mm Hg in systolic) except three obese EHs (body mass index more than 30) who demonstrated more than 160 mm Hg in systolic. Plasma aldosterone-renin ratio (ARR) of EHs did not differ from that of normal controls, and Pearson correlation coefficient (R) between ARR and systolic BP (SBP) was -0.2. Its partial correlation coefficient, however, was statistically significant (R = -0.55, P = .026) after correcting for body mass index, which was significantly correlated with both SBP (P = .006, after correcting for ARR) and ARR (P = .004, after correcting for SBP). In conclusion, most of young-onset HTs are male EHs, and aortic valve regurgitation should be carefully checked. Excess plasma renin activity would be one of additional characteristics of young-onset EH to male gender, genetic background, and increased body mass.     

Clinical Characteristics of Young-Onset and Medical Treatment-Requiring Hypertension Identified By Targeted Screening in University Health Check-Up

Based on targeted screening for hypertension at a university health check-up, we previously reported a high incidence of white-coat hypertension and estimated prevalence of hypertension requiring medical treatments (HT) as around 0.1% in young population aged less than 30. In spite of such low prevalence, continuous screening for seven consecutive years (2003–2009) increased the number of HT students to 20 (19 males and 1 female). We presently assessed the clinical characteristics of these HTs. Renovascular hypertension was found in the only female HT and aortic valve regurgitation in two HTs. Resting 17 HTs were diagnosed as having essential hypertension (EH). A father and/or a mother had EH in 16 out of 17 EHs, and blood pressure (BP) at home was slightly elevated (135–145 mm Hg in systolic) except three obese EHs (body mass index more than 30) who demonstrated more than 160 mm Hg in systolic. Plasma aldosterone-renin ratio (ARR) of EHs did not differ from that of normal controls, and Pearson correlation coefficient (R) between ARR and systolic BP (SBP) was ?0.2. Its partial correlation coefficient, however, was statistically significant (R = ?0.55, P = .026) after correcting for body mass index, which was significantly correlated with both SBP (P = .006, after correcting for ARR) and ARR (P = .004, after correcting for SBP). In conclusion, most of young-onset HTs are male EHs, and aortic valve regurgitation should be carefully checked. Excess plasma renin activity would be one of additional characteristics of young-onset EH to male gender, genetic background, and increased body mass.     

Evaluation of white coat hypertension in children: importance of the definitions of normal ambulatory blood pressure and the severity of casual hypertension

To better describe the phenomenon of white coat hypertension (WCH) in children, we reviewed our single-center experience using ambulatory blood pressure monitoring to determine: 1) how the choice of threshold limits for defining ambulatory hypertension affects the determination of WCH, and 2) whether the severity of casual hypertension predicts the occurrence of WCH. Using the same daytime ambulatory blood pressure (ABP) data from 71 children (age 11.9 ± 3.4 years) with persistently elevated casual blood pressure (BP), the prevalence of WCH was compared using 95th percentile BP limits from the Task Force on High Blood Pressure in Children (TF) and from normative pediatric daytime ambulatory BP (ABP) data. To quantify casual hypertension severity, average clinic BP was divided by the patient-specific TF 95th percentile BP to generate a BP index (ie, BP index of 1.1 = 10% above 95th percentile). The WCH prevalence was lower by normative ABP criteria than by TF criteria (31% v 59%, P < .001), but did not vary significantly by age, gender, race, or body mass index. Logistic regression showed that higher systolic BP index (P < .001) or diastolic BP index (P < .01) was associated with a lower probability of WCH. Specifically, as systolic BP index increased from 1.0 to 1.2, the estimated probability of WCH decreased from 87% to 15%, respectively. These data suggest that the use of the lower TF limits, derived solely from resting BP measurements, may overestimate WCH prevalence in ambulatory children. In addition, these data confirm in children the finding in adults that WCH is highly prevalent when casual hypertension is borderline or mild, but uncommon when moderate or severe.     

Prognosis of isolated systolic and isolated diastolic hypertension as assessed by self-measurement of blood pressure at home: the Ohasama study

BACKGROUND: Although the clinical significance of systolic-diastolic hypertension and isolated systolic hypertension has been established, the significance of isolated diastolic hypertension has not been fully investigated. OBJECTIVE: To clarify the prognostic significance of isolated systolic and isolated diastolic hypertension as assessed by self-measurement of blood pressure (BP) at home (home BP measurements), which has a better reproducibility and prognostic value than casual BP measurements in the general population. SUBJECTS AND METHODS: We obtained home BP measurements for 1913 subjects aged 40 years or older, then followed up their survival status (mean, 8.6 years). We classified the subjects into the following 4 groups according to their home BP levels: systolic-diastolic hypertension, isolated systolic hypertension, isolated diastolic hypertension, and normotension. The prognostic significance of each type of hypertension for the risk of cardiovascular mortality risk was investigated using a Cox proportional hazards regression model adjusted for possible confounding factors. RESULTS: The risk for isolated systolic hypertension and systolic-diastolic hypertension were significantly higher than the relative hazard for normotension, while isolated diastolic hypertension was associated with no significant increase in risk. Home pulse pressure measurement was also independently associated with an increase in the risk of cardiovascular mortality. CONCLUSIONS: Isolated diastolic hypertension, as assessed by home BP measurements, carried a low risk of cardiovascular mortality, similar to that found in subjects with normotension, suggesting that the prognosis of hypertension would be improved by treatment focused on systolic rather than on diastolic home BP measurements. To our knowledge, this study is the first to demonstrate the clinical significance of pulse pressure as assessed by home BP measurement. Arch Intern Med. 2000;160:3301-3306.     

白大衣高血压血管紧张素转换酶基因多态性分析

目的：研究白大衣高血压与血管紧张素转换酶（angiotensin converting enzyme，ACE）基因I／D多态性的关系。方法：应用多聚酶链式反应（PCR）方法对白大衣高血压，高血压病Ⅰ级患者和正常血压者各30例进行ACE I／D基因型检测，并分析比较。结果：白大衣高血压和高血压病Ⅰ级组Ⅱ基因型低于正常组（P〈0．01），白大衣高血压和高血压病Ⅰ级组DD基因型高于正常组（P〈0．01），白大衣高血压ID基因型显著高于高血压病Ⅰ级组和正常组（P〈0．01）。高血压病Ⅰ级组ID基因型低于正常组（P〈0．01）。结论：白大衣高血压与ACE基因多态性有关，ID基因型者易患白大衣高血压。     

Proposal of Reference Values for Home Blood Pressure Measurement: Prognostic Criteria Based on a Prospective Observation of the General Population in Ohasama,Japan

The purpose of this study was to propose reference values, from a viewpoint of prognostic significance, for blood pressure (BP) measured at home with a semiautomated device (home BP measurement) to differentiate normotension and hypertension. We obtained home BP measurements for 1,913 population-based subjects aged 40 years and over in a rural Japanese community and followed up their survival for a mean duration of 5.0 years. There were 141 deaths during the follow-up period. The association between baseline BP values and the overall mortality was examined by Cox proportional hazards regression model, adjusted for age, gender, and the use of antihypertensive medication. The results indicated that the predictive power of home BP level for subsequent mortality was stronger than that of casual screening BP. There was a linear association between home systolic BP and mortality. The association between home diastolic BP and mortality was nonlinear and well approximated with the secondary degree equation of diastolic BP values. Based on this relation, we propose that the reference value for hypertension is 137/84 mm Hg, and normotension is below 137 mm Hg for home systolic BP and between 66 and 83 mm Hg for home diastolic BP. Home diastolic BP below 66 mm Hg should be considered as low diastolic blood pressure. In this population, home systolic BP of 137 mm Hg and home diastolic BP of 84 mm Hg corresponded to the 80th and 87th percentiles, respectively. Then, 29% of the subjects were classified as having hypertension, 52% as normotension, and 19% as low diastolic blood pressure. All previous studies proposing reference values for home BP measurement, derived from cross-sectional observations, were based on the statistical distribution of home BP values. The reference value must, however, be the one that best predicts the risk for morbidity and mortality from hypertension-related complications. This is the first report proposing reference values for home BP measurement based on prognostic criteria.     

C-reactive protein and nitric oxide level in patients with white coat hypertension

Abstract Background. There are controversial results regarding the endothelial function in patients with white coat hypertension (WCH). The aim of this study was to assess endothelial function measuring nitric oxide (NO) and C-reactive protein (CRP) level in WCH and to compare those with essential hypertension (EH) and healthy subjects. Methods. The 40 newly diagnosed patients with EH, 40 patients with WCH and 40 healthy volunteers were included to study. Plasma CRP levels were measured by immunonephelometery method. Plasma NO level was also detected by using the Griess method. Results. Plasma CRP level was significantly higher in patients with EH when compared with those with WCH and healthy subjects (6.3 ± 2.1 mg/l, 2.1 ± 0.9 mg/l and 1.6 ± 1.3 mg/l, p < 0.05, respectively). However, there was no significant difference with respect to CRP level between those with WCH and healthy subjects. NO level was significantly lower in patients with EH when compared with those with WCH and healthy subjects (4.6 ± 1.1 μmol/l, 6.9 ± 1.2 μmol/l and 8.1 ± 1.5 μmol/l, p < 0.05, respectively). There was no significant difference with respect to NO level between those with WCH and healthy subjects. Plasma CRP level was positively correlated with office, daytime, night-time and 24-h blood pressure values, whereas NO level was inversely correlated with these parameters. Plasma CRP level was also inversely correlated with NO level. Conclusions. Our data suggest that CRP concentration is significantly higher and NO level is meaningfully lower in patients with essential hypertension when compared with those with WCH and controls. This may suggest that endothelial functions are preserved in patients with WCH in contrast to essential hypertension.     

Blood pressure control in subjects with type 2 diabetes

Blood pressure (BP) control of type 2 diabetic subjects aged under 65 years was assessed in a primary care setting. In addition, the usefulness of 24-h ambulatory BP measurement (ABPM) in the treatment of hypertension was assessed in subjects with diastolic BP (DBP) > or = 90 mm Hg. Of the total 381 diabetic subjects, 260 (68%) participated in the first phase, and 48 of the 110 subjects with DBP > or = 90 mm Hg were equipped with a Meditech ABPM-02 monitor in the second phase. The mean BP of the 260 participants was 156/91 (s.d. 22/11) mm Hg. According to the WHO criteria, 58% had hypertension, and 42% had a diagnosis of hypertension. Albuminuria > or = 20 micrograms/min was detected in 32% of the subjects. Ten percent of the subjects with diagnosed hypertension had a mean BP < 140/90 mm Hg and 50% had a mean BP > or = 160/95 mm Hg, as many as 38% of those not having a diagnosis of hypertension. Only long-term poor BP control in casual measurements was associated with albuminuria (42% vs 27%, P = 0.018). It is concluded that BP control was unsatisfactory and diagnosis of hypertension was delayed in most subjects with type 2 diabetes. Occurrence of microalbuminuria was associated with poor BP control and urinary albumin excretion rate may be useful in assessing the BP control. Further studies are needed to assess the position of 24-h ABPM in the treatment of hypertension of subjects with type 2 diabetes.     

White coat hypertension is a cardiovascular risk factor: a 10-year follow-up study

The objective of this paper was to evaluate the cardiovascular risk in white coat hypertension (WCH). WCH is a well-known clinical entity defined by persistently elevated blood pressure (BP) in the doctor's office, whereas BP in other conditions is normal. The prognosis of WCH is unsettled, although two prospective studies that include normal control groups imply that the condition is benign. This study is a 10-year follow-up study on 420 patients with grade I-II hypertension newly diagnosed by their general practitioner and 146 normal controls (NTs). Ambulatory blood pressure (ABP) monitoring was performed at baseline. With our protocollated cutoff value of daytime-ABP <135/90 mmHg, 76 (18.1%) of the 420 hypertensives were white coat hypertensives (WCHs) and 344 were established hypertensives (EHs). With a lower cutoff of 135/85 mmHg, 40 (9.5%) were WCHs. Complete follow-up data were obtained for all 566 subjects. The mean duration of follow-up was 10.2 years (range 9.0-12.5). In the WCH group, 14 first events were recorded (18.4%) consisting of two cardiovascular deaths and 12 nonfatal cardiovascular events. In the EH group, the corresponding number of events were 56 first events (16.3%), 12 cardiovascular deaths and 44 nonfatal cardiovascular events, and in the NT group 10 first events (6.8%), two cardiovascular deaths and eight nonfatal cardiovascular events. The event rate was similar in the WCH group and the EH group and significantly lower in the NT group (P<0.05). When corrected for daytime-ABP, age and other confounders, the difference remained statistically significant. When using the lower cutoff of 135/85 mmHg, WCH was still associated with a significantly higher cardiovascular event rate. In conclusion, the main finding of this 10-year follow-up study is an increased cardiovascular risk in WCH compared to normotensive controls.     

White coat effect in treated and untreated patients with high office blood pressure. Relationship with pulse wave velocity and left ventricular mass index.

OBJECTIVE: To evaluate in hypertensive patients whether the white coat effect is associated with target-organ damage and whether it is modified by anti-hypertensive therapy. METHODS: In a cross-sectional study we evaluated blood pressure (BP) measured in the office and by 24-h ambulatory blood pressure monitoring (ABPM), carotid-femoral pulse wave velocity (PWV) as an index of aortic stiffness, and left ventricular mass index (LVMI) in 88 subjects (aged 49 +/- 2 years) with white-coat hypertension (WCH, office BP > 140/90, daytime BP < 130/84 mmHg), 31 under antihypertensive therapy, 57 untreated, and in 115 patients with office and ambulatory hypertension (HT, aged 51 +/- 2 years, office BP > 140/90, daytime BP > 135/85), 65 under antihypertensive therapy, 50 untreated. In a longitudinal study in 15 patients with HT and in 11 patients with WCH we evaluated the influence of antihypertensive therapy (> 6 months) on office and ambulatory BP and on PWV. RESULTS: The intensity of the white coat effect (office BP-daytime BP) was greater in WCH than in HT. Taking all subjects, the white coat effect did not correlate with PWV (r = 0.08, ns) or with LVMI (r = 0.01, ns), whereas daytime BP correlated significantly with PWV (r = 0.41, p < 0.01) and with LVMI (r = 0.32, p < 0.05). WCH subjects showed lower PWV and LVMI than HT subjects. Treated and untreated WCH, with similar office and daytime BP, showed similar values of PWV and LVMI. Treated and untreated HT showed similar office BP values but treated HT showed lower daytime BP and PWV values. In the longitudinal study, antihypertensive therapy significantly reduced daytime BP and PWV values in the 15 HTs, whereas in the 11 WCH it did not alter daytime BP or PWV values. CONCLUSIONS: 1. In both WCH and HT (treated and untreated) the intensity of the white coat effect does not reflect either the severity of hypertension measured by target organ damage or the efficacy of antihypertensive treatment. 2. In WCH antihypertensive therapy does not improve either ambulatory BP values or damage to target organs.     

Target organ damage in "white coat hypertension" and "masked hypertension"

BACKGROUND: In this study we investigated (i) the prevalence of white coat hypertension (WCH) and masked hypertension (MH) in patients who had never been treated earlier with antihypertensive medication, and (ii) the association of these conditions with target organ damage. METHODS: A total of 1,535 consecutive patients underwent office blood pressure (BP) measurements, 24-h ambulatory BP monitoring (ABPM), echocardiography, and ultrasonography of the carotid arteries. Subjects who showed normotension or hypertension on the basis of both office and ambulatory BP (ABP) measurement were characterized as having confirmed normotension or confirmed hypertension, respectively. WCH was defined as office hypertension with ambulatory normotension, and MH as office normotension with ambulatory hypertension. RESULTS: WCH was found in 17.9% and MH in 14.5% of the subjects. The prevalence of WCH was significantly higher in subjects with obesity, while the prevalence of MH was significantly higher in normal-weight subjects. The confirmed hypertensive subjects as well as the masked hypertensive subjects had significantly higher left ventricular mass (LVM) (corrected for body surface area) and carotid intima media thickness (cIMT) than the confirmed normotensive subjects did (108.9 +/- 30.6, 107.1 +/- 29.1 vs. 101.4 +/- 29.9 g/m(2) and 0.68 +/- 0.16, 0.68 +/- 0.21 vs. 0.63 +/- 0.15 mm, respectively, P < 0.005). White coat hypertensive subjects did not have a significantly higher LVM index than confirmed normotensive subjects (101.5 +/- 25.9 vs. 101.4 +/- 29.9 g/m(2)); they tended to have higher cIMT than the confirmed normotensive subjects, but the difference was not statistically significant (0.67 +/- 0.15 vs. 0.63 +/- 0.15 mm). CONCLUSIONS: WCH and MH are common conditions in patients who visit hypertension outpatient clinics. Confirmed hypertension and MH are accompanied by increased LVM index and cIMT, even after adjusting for other risk factors.     

White Coat Hypertension: to Treat or Not to Treat?

Definition of white coat hypertension (WCH) traditionally relies on elevated office blood pressure (BP) during repeated visits concomitant with normal out-of-office BP values, as assessed by home and/or 24-h ambulatory BP monitoring measurements. Accumulating evidence focusing on the association of WCH with target organ damage and, more importantly, with cardiovascular events indicates that the risk conveyed by this condition is intermediate between normotension and sustained hypertension. This article will review a number of issues concerning WCH with particular emphasis on the following: (1) prevalence and clinical correlates, (2) association with target organ damage and cardiovascular events, (3) therapeutic interventions. Data will refer to the original WCH definition, based on out-of-office BP determined by 24-h ambulatory BP monitoring; at variance from home BP measurement, this approach rules out the potentially confounding effect of a clinically relevant abnormal BP phenotype such as isolated nocturnal hypertension.     

The relationship between casual and ambulatory blood pressure in essential hypertension: the influence of work, duration of hypertension and antihypertensive treatment

Casual blood pressure (BP) and ambulatory BP (mean 24-h BP) were determined in 23 untreated patients with essential hypertension and in 11 normotensive healthy control subjects. Mean 24-h BP was significantly lower than casual BP in patients with essential hypertension, but not in control subjects. This was demonstrated in the patients who did not work during the ambulatory BP monitoring and in the patients with newly recognized hypertension, whereas no differences were revealed either in the patients who went to work or had a known duration of hypertension longer than 6 months. The size of the difference between casual BP and mean 24-h BP was unaffected by antihypertensive therapy with metoprolol and also individually reproducible. An accordance between casual and ambulatory BP measurements in evaluation of the efficacy of antihypertensive treatment was found in 75% of the patients. Casual BP and mean 24-h BP were weakly correlated both before and during antihypertensive treatment. It is concluded that the higher casual BP than ambulatory BP in essential hypertension may be a specific characteristic of the disease. Both work and known duration of hypertension longer than 6 months eliminate the difference between casual ambulatory BP in essential hypertension. Ambulatory BP monitoring seems to be superior to casual BP measurements in the evaluation of antihypertensive treatment.     

Characteristics of white coat hypertension in Chinese Han patients with type 2 diabetes mellitus

Objectives: This study documented the prevalence and clinical features of white coat hypertension (WCH) among Chinese Han patients with type 2 diabetes mellitus (T₂DM). Methods: Clinic and ambulatory blood pressure (BP) measurements were compared in 856 patients with T₂DM to determine the frequency of WCH (WCH was defined as clinical blood pressure ≥140/90?mmHg and daytime blood pressure <135/85?mmHg and/or 24-h ambulatory BP (ABP) mean value of <130/80?mmHg on ambulatory BP monitoring (ABPM). Weight, waist circumference (WC), body mass index (BMI), waist to height ratio (WHtR), fasting blood glucose, glycosylated hemoglobin level and circadian BP patterns were also measured to find clinical features predictive of WCH in T₂DM. Results: The prevalence of WCH was 7.36% (63/856) in the overall population, 6.13% (29/473) in male and 8.88% (34/383) in female (p?2DM, male WC were independent protective factors, whereas female sex, smoking and alcohol consumption were independent risk factors for WCH in T₂DM. Non-dippers and reverse dippers made up larger proportion of the WCH group (p?Conclusion: WCH is relatively common among T₂DM patients, it is a unique condition distinct from essential hypertension (EH), and WCH patients also exhibit significant differences in clinical parameters.     

Clinical Implications of White Coat Hypertension

Objective: To determine the clinical implications of mild white coat hypertension (WCH).

Subjects and methods: We studied 102 subjects (54 men, 48 women). 51 of whom were normotensive and 51 slightly hypertensive. None had ever received antihypertensive therapy. An ambulatory blood pressure (ABP) record (Accutracker II), a 24-h electrocardiogram and an echocardiogram were obtained from each, and each was examined by funduscopy. WCH subjects were compared with sustained hypertension (SH) subjects and with normotensives.

Results: Fifty-three percent of the hypertensives qualified as WCH. The ultrasonographic characteristics and the ABP variables of the WCH group differed significantly from those of normotensives, but not from those of the SH group. The prevalence of left ventricilar hypertrophy (LVH) in the SH group (62.5%) did not differ significantly from its prevalence in the WCH group (40.7%). but the prevalence among normotensives (17.6%) was significantly lower than in either of the other two groups. The WCH and SH groups did not differ significantly as regards the prevalence of hypertensive retinopathy (33.3%) in the former, 58.3% in the latter). For no non-LVH, nonretinopathic subject, whether norniotensive or hypertensive, were more than 18% of daytime diastolic ABP measurements ≥90mmHg. Ultrasonographic findings were no better correlated with ABP than with in-clinic BP measurements. Fundus findings correlated well with in-clinic BP and with numerous ABP parameters. Retinopathy, with or without LVH, was efficiently predictable among hypertensives on the basis of body mass index and the 24-h maximum of systolic BP.

Conclusions: Myocardiac remodelling and vascular retinopathy develop early and in parallel in hypertensives, and both developments appear to involve determinants including body mass index and 24-h maximum systolic BP. WCH subjects, as defined by current ABP-based criteria, have cardiac and retinovascular Characteristics different to normotensive subjects. Stricter criteria are needed to discriminate between hypertensives with and without the systemic developments that constitute the immediate source of risk to the hypertensive individual.     

白大衣高血压患者的血小板功能

目的:探讨白大衣高血压(WCH)患者的血小板功能.方法:选初诊的原发性高血压(EH)患者、 WCH 患者、正常血压(NT)者各35例,通过诊室血压测量和24 h动态血压监测,同时测定并比较3组血小板最大聚集率(PAGTmax)、血浆血小板α-颗粒膜蛋白(GMP-140)含量、平均血小板容积(MPV) 、血小板数量的变化.结果:和NT对照组相比,EH组和WCH组 PAGTmax、血浆血小板GMP-140含量、MPV均明显增加(P<0.05)而三组血小板计数无统计学差异,同时EH组的PAGTmax、血浆血小板GMP-140含量、MPV均高于WCH组(P<0.05).EH组和WCH组MPV与24 h平均舒张压、GMP-140含量均正相关( P<0.05).结论:WCH存在血小板活化,可能和心血管事件发生率增加有关.     

Masked hypertension in elderly managerial employees and retirees

Masked hypertension is reported to have the same level of hazard risk of cardiovascular mortality and stroke morbidity as sustained hypertension. The number of managerial employees suffering from cardiovascular disease and stroke is known to be greater than other employee. The aim of this study was to compare the 24-h blood pressure (BP) recordings between elderly male managerial employees and retirees and to propose a strategy for identifying masked hypertension. A total of 38 males (16 managerial employees aged 50-69 years and 22 retirees aged 60-65 years) who were not taking any antihypertensive medications participated in this study. Their 24-h BP was measured by an ambulatory BP monitoring device. Daytime (9:00-17:00 h) BPs of the employees (mean, 139/92 mm Hg) were significantly higher than in the retirees (mean 124/80 mm Hg), while there was no difference in BP before and during sleep. In all, 5 of 16 employees (31%) who were diagnosed as normotensive (<140/90 mm Hg) at a periodic health check had hypertension (>135/85 mm Hg) in the morning measured by ambulatory BP monitoring, while 6 (38%) had a similar level of hypertension during the daytime (9:00-17:00 h). These individuals were diagnosed as having masked hypertension. Multiple regression analyses showed that the job was the only factor that contributed to the difference in BP in the subjects during the daytime. This finding suggested that job stress seemed to be one of the main causes of masked hypertension. We argue that more frequent measurements of BP at the work place are necessary to identify subjects with masked hypertension.