The Cardiovascular Risk of White-Coat Hypertension

Stanley S Franklin; Lutgarde Thijs; Kei Asayama; Yan Li; Tine W Hansen; José Boggia; Lotte Jacobs; Zhenyu Zhang; Masahiro Kikuya; Kristina Björklund-Bodegård; Takayoshi Ohkubo; Wen-Yi Yang; Jørgen Jeppesen; Eamon Dolan; Tatiana Kuznetsova; Katarzyna Stolarz-Skrzypek; Valérie Tikhonoff; Sofia Malyutina; Edoardo Casiglia; Yuri Nikitin; Lars Lind; Edgardo Sandoya; Kalina Kawecka-Jaszcz; Jan Filipovský; Yutaka Imai; Ji-Guang Wang; Eoin O'Brien; Jan A Staessen; IDACO Investigators

doi:10.1016/j.jacc.2016.08.035

The Cardiovascular Risk of White-Coat Hypertension

Stanley S Franklin, Lutgarde Thijs, Kei Asayama, Yan Li, Tine W Hansen, José Boggia, Lotte Jacobs, Zhenyu Zhang, Masahiro Kikuya, Kristina Björklund-Bodegård, Takayoshi Ohkubo, Wen-Yi Yang, Jørgen Jeppesen, Eamon Dolan, Tatiana Kuznetsova, Katarzyna Stolarz-Skrzypek, Valérie Tikhonoff, Sofia Malyutina, Edoardo Casiglia, Yuri NikitinLars Lind, Edgardo Sandoya, Kalina Kawecka-Jaszcz, Jan Filipovský, Yutaka Imai, Ji-Guang Wang, Eoin O'Brien, Jan A Staessen, IDACO Investigators

Medicinsk Afdeling GLO

125 Citationer (Scopus)

Abstract

BACKGROUND: The role of white-coat hypertension (WCH) and the white-coat-effect (WCE) in development of cardiovascular disease (CVD) risk remains poorly understood.

OBJECTIVES: Using data from the population-based, 11-cohort IDACO (International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes), this study compared daytime ambulatory blood pressure monitoring with conventional blood pressure measurements in 653 untreated subjects with WCH and 653 normotensive control subjects.

METHODS: European Society Hypertension guidelines were used as a 5-stage risk score. Low risk was defined as 0 to 2 risk factors, and high risk was defined as ≥3 to 5 risk factors, diabetes, and/or history of prior CVD events. Age- and cohort-matching was done between 653 untreated subjects with WCH and 653 normotensive control subjects.

RESULTS: In a stepwise linear regression model, systolic WCE increased by 3.8 mm Hg (95% confidence interval [CI]: 3.1 to 4.6 mm Hg) per 10-year increase in age, and was similar in low- and high-risk subjects with or without prior CVD events. Over a median 10.6-year follow-up, incidence of new CVD events was higher in 159 high-risk subjects with WCH compared with 159 cohort- and age-matched high-risk normotensive subjects (adjusted hazard ratio [HR]: 2.06; 95% CI: 1.10 to 3.84; p = 0.023). The HR was not significant for 494 participants with low-risk WCH and age-matched low-risk normotensive subjects. Subgroup analysis by age showed that an association between WCH and incident CVD events is limited to older (age ≥60 years) high-risk WCH subjects; the adjusted HR was 2.19 (95% CI: 1.09 to 4.37; p = 0.027) in the older high-risk group and 0.88 (95% CI: 0.51 to 1.53; p = 0.66) in the older low-risk group (p for interaction = 0.044).

CONCLUSIONS: WCE size is related to aging, not to CVD risk. CVD risk in most persons with WCH is comparable to age- and risk-adjusted normotensive control subjects.

Originalsprog	Engelsk
Tidsskrift	Journal of the American College of Cardiology
Vol/bind	68
Udgave nummer	19
Sider (fra-til)	2033-2043
Antal sider	11
ISSN	0735-1097
DOI	https://doi.org/10.1016/j.jacc.2016.08.035
Status	Udgivet - nov. 2016

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10.1016/j.jacc.2016.08.035

Citationsformater

Franklin, S. S., Thijs, L., Asayama, K., Li, Y., Hansen, T. W., Boggia, J., Jacobs, L., Zhang, Z., Kikuya, M., Björklund-Bodegård, K., Ohkubo, T., Yang, W.-Y., Jeppesen, J., Dolan, E., Kuznetsova, T., Stolarz-Skrzypek, K., Tikhonoff, V., Malyutina, S., Casiglia, E., ... IDACO Investigators (2016). The Cardiovascular Risk of White-Coat Hypertension. Journal of the American College of Cardiology, 68(19), 2033-2043. https://doi.org/10.1016/j.jacc.2016.08.035

Franklin, SS, Thijs, L, Asayama, K, Li, Y, Hansen, TW, Boggia, J, Jacobs, L, Zhang, Z, Kikuya, M, Björklund-Bodegård, K, Ohkubo, T, Yang, W-Y, Jeppesen, J, Dolan, E, Kuznetsova, T, Stolarz-Skrzypek, K, Tikhonoff, V, Malyutina, S, Casiglia, E, Nikitin, Y, Lind, L, Sandoya, E, Kawecka-Jaszcz, K, Filipovský, J, Imai, Y, Wang, J-G, O'Brien, E, Staessen, JA & IDACO Investigators 2016, 'The Cardiovascular Risk of White-Coat Hypertension', Journal of the American College of Cardiology, bind 68, nr. 19, s. 2033-2043. https://doi.org/10.1016/j.jacc.2016.08.035

@article{c8ce2fec026d43e99569b71dcf7043d9,

title = "The Cardiovascular Risk of White-Coat Hypertension",

abstract = "BACKGROUND: The role of white-coat hypertension (WCH) and the white-coat-effect (WCE) in development of cardiovascular disease (CVD) risk remains poorly understood.OBJECTIVES: Using data from the population-based, 11-cohort IDACO (International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes), this study compared daytime ambulatory blood pressure monitoring with conventional blood pressure measurements in 653 untreated subjects with WCH and 653 normotensive control subjects.METHODS: European Society Hypertension guidelines were used as a 5-stage risk score. Low risk was defined as 0 to 2 risk factors, and high risk was defined as ≥3 to 5 risk factors, diabetes, and/or history of prior CVD events. Age- and cohort-matching was done between 653 untreated subjects with WCH and 653 normotensive control subjects.RESULTS: In a stepwise linear regression model, systolic WCE increased by 3.8 mm Hg (95% confidence interval [CI]: 3.1 to 4.6 mm Hg) per 10-year increase in age, and was similar in low- and high-risk subjects with or without prior CVD events. Over a median 10.6-year follow-up, incidence of new CVD events was higher in 159 high-risk subjects with WCH compared with 159 cohort- and age-matched high-risk normotensive subjects (adjusted hazard ratio [HR]: 2.06; 95% CI: 1.10 to 3.84; p = 0.023). The HR was not significant for 494 participants with low-risk WCH and age-matched low-risk normotensive subjects. Subgroup analysis by age showed that an association between WCH and incident CVD events is limited to older (age ≥60 years) high-risk WCH subjects; the adjusted HR was 2.19 (95% CI: 1.09 to 4.37; p = 0.027) in the older high-risk group and 0.88 (95% CI: 0.51 to 1.53; p = 0.66) in the older low-risk group (p for interaction = 0.044).CONCLUSIONS: WCE size is related to aging, not to CVD risk. CVD risk in most persons with WCH is comparable to age- and risk-adjusted normotensive control subjects.",

author = "Franklin, {Stanley S} and Lutgarde Thijs and Kei Asayama and Yan Li and Hansen, {Tine W} and Jos{\'e} Boggia and Lotte Jacobs and Zhenyu Zhang and Masahiro Kikuya and Kristina Bj{\"o}rklund-Bodeg{\aa}rd and Takayoshi Ohkubo and Wen-Yi Yang and J{\o}rgen Jeppesen and Eamon Dolan and Tatiana Kuznetsova and Katarzyna Stolarz-Skrzypek and Val{\'e}rie Tikhonoff and Sofia Malyutina and Edoardo Casiglia and Yuri Nikitin and Lars Lind and Edgardo Sandoya and Kalina Kawecka-Jaszcz and Jan Filipovsk{\'y} and Yutaka Imai and Ji-Guang Wang and Eoin O'Brien and Staessen, {Jan A} and {IDACO Investigators}",

year = "2016",

month = nov,

doi = "10.1016/j.jacc.2016.08.035",

language = "English",

volume = "68",

pages = "2033--2043",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier Inc.",

number = "19",

}

TY - JOUR

T1 - The Cardiovascular Risk of White-Coat Hypertension

AU - Franklin, Stanley S

AU - Thijs, Lutgarde

AU - Asayama, Kei

AU - Li, Yan

AU - Hansen, Tine W

AU - Boggia, José

AU - Jacobs, Lotte

AU - Zhang, Zhenyu

AU - Kikuya, Masahiro

AU - Björklund-Bodegård, Kristina

AU - Ohkubo, Takayoshi

AU - Yang, Wen-Yi

AU - Jeppesen, Jørgen

AU - Dolan, Eamon

AU - Kuznetsova, Tatiana

AU - Stolarz-Skrzypek, Katarzyna

AU - Tikhonoff, Valérie

AU - Malyutina, Sofia

AU - Casiglia, Edoardo

AU - Nikitin, Yuri

AU - Lind, Lars

AU - Sandoya, Edgardo

AU - Kawecka-Jaszcz, Kalina

AU - Filipovský, Jan

AU - Imai, Yutaka

AU - Wang, Ji-Guang

AU - O'Brien, Eoin

AU - Staessen, Jan A

AU - IDACO Investigators

PY - 2016/11

Y1 - 2016/11

N2 - BACKGROUND: The role of white-coat hypertension (WCH) and the white-coat-effect (WCE) in development of cardiovascular disease (CVD) risk remains poorly understood.OBJECTIVES: Using data from the population-based, 11-cohort IDACO (International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes), this study compared daytime ambulatory blood pressure monitoring with conventional blood pressure measurements in 653 untreated subjects with WCH and 653 normotensive control subjects.METHODS: European Society Hypertension guidelines were used as a 5-stage risk score. Low risk was defined as 0 to 2 risk factors, and high risk was defined as ≥3 to 5 risk factors, diabetes, and/or history of prior CVD events. Age- and cohort-matching was done between 653 untreated subjects with WCH and 653 normotensive control subjects.RESULTS: In a stepwise linear regression model, systolic WCE increased by 3.8 mm Hg (95% confidence interval [CI]: 3.1 to 4.6 mm Hg) per 10-year increase in age, and was similar in low- and high-risk subjects with or without prior CVD events. Over a median 10.6-year follow-up, incidence of new CVD events was higher in 159 high-risk subjects with WCH compared with 159 cohort- and age-matched high-risk normotensive subjects (adjusted hazard ratio [HR]: 2.06; 95% CI: 1.10 to 3.84; p = 0.023). The HR was not significant for 494 participants with low-risk WCH and age-matched low-risk normotensive subjects. Subgroup analysis by age showed that an association between WCH and incident CVD events is limited to older (age ≥60 years) high-risk WCH subjects; the adjusted HR was 2.19 (95% CI: 1.09 to 4.37; p = 0.027) in the older high-risk group and 0.88 (95% CI: 0.51 to 1.53; p = 0.66) in the older low-risk group (p for interaction = 0.044).CONCLUSIONS: WCE size is related to aging, not to CVD risk. CVD risk in most persons with WCH is comparable to age- and risk-adjusted normotensive control subjects.

AB - BACKGROUND: The role of white-coat hypertension (WCH) and the white-coat-effect (WCE) in development of cardiovascular disease (CVD) risk remains poorly understood.OBJECTIVES: Using data from the population-based, 11-cohort IDACO (International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes), this study compared daytime ambulatory blood pressure monitoring with conventional blood pressure measurements in 653 untreated subjects with WCH and 653 normotensive control subjects.METHODS: European Society Hypertension guidelines were used as a 5-stage risk score. Low risk was defined as 0 to 2 risk factors, and high risk was defined as ≥3 to 5 risk factors, diabetes, and/or history of prior CVD events. Age- and cohort-matching was done between 653 untreated subjects with WCH and 653 normotensive control subjects.RESULTS: In a stepwise linear regression model, systolic WCE increased by 3.8 mm Hg (95% confidence interval [CI]: 3.1 to 4.6 mm Hg) per 10-year increase in age, and was similar in low- and high-risk subjects with or without prior CVD events. Over a median 10.6-year follow-up, incidence of new CVD events was higher in 159 high-risk subjects with WCH compared with 159 cohort- and age-matched high-risk normotensive subjects (adjusted hazard ratio [HR]: 2.06; 95% CI: 1.10 to 3.84; p = 0.023). The HR was not significant for 494 participants with low-risk WCH and age-matched low-risk normotensive subjects. Subgroup analysis by age showed that an association between WCH and incident CVD events is limited to older (age ≥60 years) high-risk WCH subjects; the adjusted HR was 2.19 (95% CI: 1.09 to 4.37; p = 0.027) in the older high-risk group and 0.88 (95% CI: 0.51 to 1.53; p = 0.66) in the older low-risk group (p for interaction = 0.044).CONCLUSIONS: WCE size is related to aging, not to CVD risk. CVD risk in most persons with WCH is comparable to age- and risk-adjusted normotensive control subjects.

U2 - 10.1016/j.jacc.2016.08.035

DO - 10.1016/j.jacc.2016.08.035

M3 - Journal article

C2 - 27810041

SN - 0735-1097

VL - 68

SP - 2033

EP - 2043

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 19

ER -

The Cardiovascular Risk of White-Coat Hypertension

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