Setting Thresholds to Varying Blood Pressure Monitoring Intervals Differentially Affects Risk Estimates Associated With White-Coat and Masked Hypertension in the Population

Kei Asayama, Lutgarde Thijs, Yan Li, Yu-Mei Gu, Azusa Hara, Yan-Ping Liu, Zhenyu Zhang, Fang-Fei Wei, Ines Lujambio, Luis J. Mena, Jose Boggia, Tine W. Hansen, Kristina Bjoerklund-Bodegard, Kyoko Nomura, Takayoshi Ohkubo, Jorgen Jeppesen, Christian Torp-Pedersen, Eamon Dolan, Katarzyna Stolarz-Skrzypek, Sofia MalyutinaEdoardo Casiglia, Yuri Nikitin, Lars Lind, Leonella Luzardo, Kalina Kawecka-Jaszcz, Edgardo Sandoya, Jan Filipovsky, Gladys E. Maestre, Jiguang Wang, Yutaka Imai, Stanley S. Franklin, Eoin O'Brien, Jan A. Staessen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

103 Citations (Web of Science)


Outcome-driven recommendations about time intervals during which ambulatory blood pressure should be measured to diagnose white-coat or masked hypertension are lacking. We cross-classified 8237 untreated participants (mean age, 50.7 years; 48.4% women) enrolled in 12 population studies, using >= 140/>= 90, >= 130/>= 80, >= 135/>= 85, and >= 120/>= 70 mm Hg as hypertension thresholds for conventional, 24-hour, daytime, and nighttime blood pressure. White-coat hypertension was hypertension on conventional measurement with ambulatory normotension, the opposite condition being masked hypertension. Intervals used for classification of participants were daytime, nighttime, and 24 hours, first considered separately, and next combined as 24 hours plus daytime or plus nighttime, or plus both. Depending on time intervals chosen, white-coat and masked hypertension frequencies ranged from 6.3% to 12.5% and from 9.7% to 19.6%, respectively. During 91 046 person-years, 729 participants experienced a cardiovascular event. In multivariable analyses with normotension during all intervals of the day as reference, hazard ratios associated with white-coat hypertension progressively weakened considering daytime only (1.38; P=0.033), nighttime only (1.43; P=0.0074), 24 hours only (1.21; P=0.20), 24 hours plus daytime (1.24; P=0.18), 24 hours plus nighttime (1.15; P=0.39), and 24 hours plus daytime and nighttime (1.16; P=0.41). The hazard ratios comparing masked hypertension with normotension were all significant (P
Original languageEnglish
Pages (from-to)935-+
Issue number5
Publication statusPublished - Nov 2014


  • ambulatory blood pressure monitoring
  • cardiovascular risk
  • masked hypertension
  • population science
  • white-coat hypertension

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