CONTEMPORARY PROBLEMS OF EVALUATION OF HYPERTENSION TREATMENT EFFICACY: MASKED HYPERTENSION AND WHITE COAT HYPERTENSION

The implementation of contemporary ambulatory methods of BP level evaluation in clinical practice improved diagnostics of arterial hypertension (HT), but at the same time faced with specific problems. White coat HT (WCHT) and masked HT are characterized by inconsistency between ambulatory and clinical BP levels. Studying of these conditions in patients receiving antihypertensive therapy is important. The WCHT during treatment (target ambulatory BP levels and no control of clinical BP) is observed in 10-20% of patients. The cardiovascular risk in these patients does not differ significantly from the risk in patients with controlled BP. Masked HT (target levels of clinical BP and no control of ambulatory BP) is observed in 5,4-23% of patients. The cardiovascular risk in patients with masked HT is 2,5-3,0 times more than that in patients with controlled HT and comparable with risk in patients with ineffective antihypertensive therapy. Thus, clinical measurements can give inexact data about true BP level in one third of treated hypertensive patients. Therefore the evaluation of cardiovascular risk and correct usage of ambulatory BP measurement is important for choice of therapy tactics in patients with HT. 

1. Mancia G., Facchetti R., Bombelli M. et al. Long-term risk of mortality associated with selective and combined elevation in office, home and ambulatory blood pressure. Hypertension 2006;47(5):846-53.

2. Pickering T.G., Eguchi K., Kario K. Masked hypertension: a review. Hypertens Res 2007;30(6):479-88.

3. Fagard R.H., Cornelissen A. Incidence of cardiovascular events in white-coat, masked and sustained hypertension versus true normotension: a meta-analysis. J Hypertens 2007;25(11):2193-8.

4. Pickering T.G., Coats A., Mallion J.M. et al. Blood Pressure Monitoring. Task force V: White-coat hypertension. Blood Press Monit 1999;4(6):333-41.

5. Management of Arterial Hypertension of the European Society of Hypertension; European Society of Cardiology. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007;25(6):1105-87.

6. Verberk W.J., Thien T., Kroon A.A. et al. Prevalence and persistence of masked hypertension in treated hypertensive patients. Am J Hypertens 2007;20 (12):1258-65.

7. Горбунов В.М. Использование СМАД для оценки эффективности гипотензивной терапии. Нижний Новгород: ДЕКОМ; 2006.

8. Staessen J., Amery A. APTH--a trial on ambulatory blood pressure monitoring and treatment of hypertension: objectives and protocol. Acta Cardiol 1993;48(1):25-42.

9. European Society of Hypertension Working Group on Blood Pressure Monitoring. European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens 2003; 21(5):821-48.

10. Muxfeldt E.S., Bloch K.V., Nogueira A.R., Salles G.F. Twenty-four hour ambulatory blood pressure monitoring pattern of resistant hypertension. Blood Press Monit 2003;8(5):181-5.

11. Verberk W.J., Kessels A.G.H., de Leeuw P.W. Prevalence, causes and consequences of masked hypertension: a meta-analysis. Am J Hypertens 2008;21(9):969-75.

12. Aksoy I., Deinum J., Lenders J.W., Thien T. Does masked hypertension exist in healthy volunteers and apparently well-controlled hypertensive patients? Neth J Med 2006;64(3):72-7.

13. Ben-Dov I.Z., Ben-Arie L., Mekler J., Bursztyn M. In clinical practice, masked hypertension is as common as isolated clinic hypertension: predominance of younger men. Am J Hypertens 2005; 18(5 Pt 1):589-93.

14. Bobrie G., Clerson P., Cuchet A., Mahmoudi A. et al. Prevalence and mechanism of masked hypertension: the ol′mesures survey [in French]. Arch Mal Coeur Vaiss 2006;99(7-8):760-3.

15. Ishikava J.,Kario K., Eguchi K. et al. Regular alcohol drinking is a determinant of masked morning hypertension detected by home blood pressure monitoring in medicated hypertensive patients with well-controlled clinic blood pressure: the Jichi Morning Hypertension Research (J-MORE) study. Hypertens Res 2006;29(9):679-86.

16. Kato T., Horio T., Tomiyama M. et al. Reverse white-coat effect as an independent risk for microalbuminuria in treated hypertensive patients. Nephrol Dial Transplant 2007;22(3):911-6.

17. Kuriyama S., Otsuka Y., Iida R. et al. Morning blood pressure predicts hypertensive organ damage in patients with renal diseases: effect of inten￾sive antihypertensive therapy in patients with diabetic nephropathy. Intern Med 2005;44(12):1239-46.

18. Obara T., Ohkubo T., Kikuya M. et al. 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. Blood Press Monit 2005;10(6):311-6.

19. Pierdomenico S.D., Lapenna D., Bucci A. et al. Cardiovascular outcome in treated hypertensive patients with responder, masked, false resistant, and true resistant hypertension. Am J Hypertens 2005;18(11):1422-8.

20. Ragot S., Ezzaher A., Meunier A. et al. Comparison of trough effect of telmisartan vs perindopril using self blood pressure measurement: EVERESTE study. J Hum Hypertens 2002;16(12):865-73.

21. Tomiyama M., Horio T., Yoshii M et al. Masked hypertension and target organ damage in treated hypertensive patients. Am J Hypertens 2006;19(9):880-6.

22. Ungar A., Pepe G., Monami M. et al. Isolated ambulatory hypertension is common in outpatients referred to a hypertension centre. J Hum Hypertens 2004;18(12):897-903.

23. Wing L.M., Brown M.A., Beilin L.J. et al. ′Reverse white-coat hypertension′ in older hypertensives. J Hypertens 2002;20(4):639-44.

24. Banegas J.R., Segura J., Sobrino J et al. Effectiveness of blood pressure control outside the medical setting. Hypertension 2007;49(1):62-8.

25. Kario K. Clinician's Manual on Early Morning Risk Management in Hypertension. London: Science Press; 2004.

26. Clement D.L., De Buyzere M.L., De Bacquer D.A. et al. Prognostic value of ambulatory blood-pressure recordings in patients with treated hypertension. New Engl J Med 2003; 348(24):2407-15.

27. Bobrie G., Chatellier G., Genes N. et al. Cardiovascular prognosis of "masked hypertension" detected by blood pressure self-measurement in elderly treated hypertensive patients. JAMA 2004;291(11):1342-9.

28. Pierdomenico S.D., Lapenna D., Di Tommaso R. et al. Cardiovascular risk in patients receiving double therapy with false and true nonresponder hypertension. Blood Press Monit 2006;11(6):303-7.

29. Lacourcière Y., Carrier M., Toal C.B. Efficacy and tolerability of tiapamil in patients with mild to moderate essential hypertension. J Cardiovasc Pharmacol 1989;14(1):166-70.

30. Bobrie G., Clerson P., Ménard J. et al. Masked hypertension: a systematic review. J Hypertens 2008;26(9):1715-25.

31. Palatini P. Masked hypertension: how can the condition be detected? Blood Press Monit 2004;9(6):297-9.

32. Siegrist J., Junge A. Conceptual and methodological problems in research on the quality of life in clinical medicine. Soc Sci Med 1989;29(3):463-8.

33. Ohkubo T., Kikuya M., Metoki H. et al. Prognosis of “Masked” hypertension and “White-coat” hypertension detected by 24-h ambulatory blood pressure monitoring. J Am Coll Cardiol 2005;46(3):508-15.

34. Диагностика и лечение артериальной гипертензии. Российские рекомендации (третий пересмотр). Кардиоваскулярная терапия и профилактика 2008;6(приложение 2):3-32.