Fujiwara T, et al. - Researchers evaluated the link between masked hypertension and cardiovascular disease events in clinical settings. They concluded that masked hypertension defined by home blood pressure monitoring (HBPM) may be related to an increased risk for stroke events in the Japanese general practice population. They also suggested that an improved assessment of blood pressure (BP)-related risks may be achieved and new therapeutic interventions aimed at preventing cardiovascular disease events may be identified by using HBPM.

Methods

• Researchers performed this observational cohort study by using data from 4,261 outpatients treated at 71 primary practices or university hospitals throughout Japan who were enrolled in the Japan Morning Surge–Home Blood Pressure study between January 1 2005, and December 31, 2012.
• They included subjects who had a history of or risk factors for cardiovascular disease and were followed up through March 31, 2015; these subjects were asked to undergo clinic blood pressure (BP) measurements on two occasions as well as HBPM measurements in the morning and evening for a 14-day period.
• They quantified urine albumin to creatinine ratio and circulating brain (or B-type) natriuretic peptide levels at baseline as a marker of cardiovascular end-organ damage.
• From July 1, 2017 to October 31, 2017, they carried out data analysis.
• Four BP patient groups were formed: masked hypertension—hypertensive home BP levels (systolic, ≥135 mm Hg; diastolic, ≥85 mm Hg) and nonhypertensive clinic BP levels (systolic, <140 mm Hg; diastolic, <90 mm Hg); white-coat hypertension—nonhypertensive home BP levels (systolic, <135 mm Hg; diastolic, <85 mm Hg) and hypertensive clinic BP levels (systolic, ≥140 mm Hg; diastolic, ≥90 mm Hg); sustained hypertension—hypertensive home and clinic BP levels; and controlled BP—nonhypertensive home and clinic BP levels.
• Main outcomes and measures included incident stroke and coronary heart disease.

Results

• A total of 4,261 participants were included.
• Study population included 2,266 (53.2%) women, 3,374 (79.2%) subjects taking antihypertensive medication, with mean (SD) age 64.9 (10.9) years.
• Findings reported the occurrence of 74 stroke (4.4 per 1,000 person-years) and 77 coronary heart disease (4.6 per 1,000 person-years) events during a median (interquartile range) follow-up of 3.9 (2.4-4.6) years.
• A greater risk for stroke was reported for the masked hypertension group vs the controlled BP group (hazard ratio, 2.77; 95% CI, 1.20-6.37), independent of traditional cardiovascular risk factors, urine albumin to creatinine ratio, and circulating B-type natriuretic peptide levels.
• Data showed that masked hypertension yielded no association with coronary heart disease risk.