Average daily blood pressure, not office blood pressure, determines cardiac function in patients with hypertension

W. B. White, P. Schulman, E. J. McCabe and H. M. Dey
Section of Hypertension, University of Connecticut School of Medicine, Farmington 06032.

To determine the presence of cardiac disease in hypertensive patients with disparities between physician and out-of-office blood pressures, we prospectively studied three groups of age-matched patients identified by both casual (office) and ambulatory blood pressures: (1) office blood pressure greater than 140/90 mm Hg and awake ambulatory blood pressure of 130/80 mm Hg or less ("office" hypertensives); (2) office blood pressure less than 135/85 mm Hg and awake ambulatory blood pressure of 130/80 mm Hg or less (normotensives); and (3) office blood pressure greater than 140/90 mm Hg and awake ambulatory blood pressure of 140/90 mm Hg or greater ("daytime" hypertensives). In the patients with office hypertension, both the left atrial index and left ventricular mass index were significantly less than in patients with daytime hypertension and not statistically different from those of the normotensive subjects. Left ventricular filling rate at rest and ejection fraction at peak exercise were significantly greater in the office hypertensive group than in the daytime hypertensive group but were no different from those of the normotensive subjects. These findings demonstrate that patients with blood pressure elevation only in the physician's office have cardiac size and function similar to those of normotensive individuals. Thus, the average daily blood pressure best predicts cardiac end-organ damage.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Prevalence and Correlates of Left Ventricular Hypertrophy in the African American Study of Kidney Disease Cohort Study
Peterson et al.
Hypertension 2007;50:1033-1039.
ABSTRACT | FULL TEXT  

Routine Use of Ambulatory Blood Pressure Monitoring in Potential Living Kidney Donors
Ommen et al.
CJASN 2007;2:1030-1036.
ABSTRACT | FULL TEXT  

Effects of Continuous Positive Airway Pressure Versus Supplemental Oxygen on 24-Hour Ambulatory Blood Pressure
Norman et al.
Hypertension 2006;47:840-845.
ABSTRACT | FULL TEXT  

Short- and Long-Term Incidence of Stroke in White-Coat Hypertension
Verdecchia et al.
Hypertension 2005;45:203-208.
ABSTRACT | FULL TEXT  

Surrogate Markers for Cardiovascular Disease: Functional Markers
Cohn et al.
Circulation 2004;109:IV-31-IV-46.
FULL TEXT  

Hypertensive Target-Organ Damage in the Very Elderly
O'Sullivan et al.
Hypertension 2003;42:130-135.
ABSTRACT | FULL TEXT  

Ambulatory Blood Pressure and Left Ventricular Mass Index in Hypertensive Children
Sorof et al.
Hypertension 2002;39:903-908.
ABSTRACT | FULL TEXT  

Effects of Celecoxib on Ambulatory Blood Pressure in Hypertensive Patients on ACE Inhibitors
White et al.
Hypertension 2002;39:929-934.
ABSTRACT | FULL TEXT  

Properly defining white coat hypertension
Verdecchia et al.
Eur Heart J 2002;23:106-109.
FULL TEXT  

Left Ventricular Changes in Isolated Office Hypertension: A Blood Pressure-Matched Comparison With Normotension and Sustained Hypertension
Grandi et al.
Arch Intern Med 2001;161:2677-2681.
ABSTRACT | FULL TEXT  

Is "Isolated Home" Hypertension as Opposed to "Isolated Office" Hypertension a Sign of Greater Cardiovascular Risk?
Bobrie et al.
Arch Intern Med 2001;161:2205-2211.
ABSTRACT | FULL TEXT  

Raised urinary glucocorticoid and adrenal androgen precursors in the urine of young hypertensive patients: possible evidence for partial glucocorticoid resistance
Shamim et al.
Heart 2001;86:139-144.
ABSTRACT | FULL TEXT  

Silent and clinically overt stroke in older Japanese subjects with white-coat and sustained hypertension
Kario et al.
J Am Coll Cardiol 2001;38:238-245.
ABSTRACT | FULL TEXT  

Individualized Stress Management for Primary Hypertension: A Randomized Trial
Linden et al.
Arch Intern Med 2001;161:1071-1080.
ABSTRACT | FULL TEXT  

Dipping Status May Be Determined by Nocturnal Urination
Perk et al.
Hypertension 2001;37:749-752.
ABSTRACT | FULL TEXT  

The Urgent Need to Improve Hypertension Care
Trilling and Froom
Arch Fam Med 2000;9:794-801.
ABSTRACT | FULL TEXT  

Ambulatory Blood Pressure Monitoring and Postprandial Hypotension in Elderly Persons With Falls or Syncopes
Puisieux et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2000;55:535M-540.
ABSTRACT | FULL TEXT  

Reducing Antihypertensive Medication Use in Nursing Home Patients
Froom and Trilling
Arch Fam Med 2000;9:378-383.
ABSTRACT | FULL TEXT  

Prognostic Value of Ambulatory Blood Pressure : Current Evidence and Clinical Implications
Verdecchia
Hypertension 2000;35:844-851.
ABSTRACT | FULL TEXT  

Prognostic Value of 24-Hour Blood Pressure in Pregnancy
Bellomo et al.
JAMA 1999;282:1447-1452.
ABSTRACT | FULL TEXT  

Cardiovascular Outcome in White-Coat Versus Sustained Mild Hypertension : A 10-Year Follow-Up Study
Khattar et al.
Circulation 1998;98:1892-1897.
ABSTRACT | FULL TEXT  

Reference Values for 24-Hour Ambulatory Blood Pressure Monitoring Based on a Prognostic Criterion : The Ohasama Study
Ohkubo et al.
Hypertension 1998;32:255-259.
ABSTRACT | FULL TEXT  

Changes of Circadian Blood Pressure Patterns Are Associated With the Occurrence of Lacunar Infarction
Kukla et al.
Arch Neurol 1998;55:683-688.
ABSTRACT | FULL TEXT  

Circadian Blood Pressure Variation in Hypertensive Patients With Primary Hyperaldosteronism
Mansoor and White
Hypertension 1998;31:843-847.
ABSTRACT | FULL TEXT  

Low-Density Lipoprotein Oxidation and Vitamins E and C in Sustained and White-Coat Hypertension
Pierdomenico et al.
Hypertension 1998;31:621-626.
ABSTRACT | FULL TEXT  

Prognostic Value of Ambulatory Blood Pressure Monitoring in Refractory Hypertension : A Prospective Study
Redon et al.
Hypertension 1998;31:712-718.
ABSTRACT | FULL TEXT  

Target-Organ Damage in Stage I Hypertensive Subjects With White Coat and Sustained Hypertension: Results From the HARVEST Study
Palatini et al.
Hypertension 1998;31:57-63.
ABSTRACT | FULL TEXT  

Left Ventricular Filling Profiles in Young White-Coat Hypertensive Patients Without Hypertrophy
Chang et al.
Hypertension 1997;30:746-752.
ABSTRACT | FULL TEXT  

Prognostic Significance of the White Coat Effect
Verdecchia et al.
Hypertension 1997;29:1218-1224.
ABSTRACT | FULL TEXT  

Confirmation or Exclusion of Stage I Hypertension by Ambulatory Blood Pressure Monitoring
Moore et al.
Hypertension 1997;29:1109-1113.
ABSTRACT | FULL TEXT  

Ambulatory Blood Pressure Monitoring in Acute Stroke: The West Birmingham Stroke Project
Lip et al.
Stroke 1997;28:31-35.
ABSTRACT | FULL TEXT  

Nocturnal Blood Pressure and Silent Cerebrovascular Lesions in Elderly Japanese
Watanabe et al.
Stroke 1996;27:1319-1327.
ABSTRACT | FULL TEXT  

Target Organ Status and Serum Lipids in Patients With White Coat Hypertension
Pierdomenico et al.
Hypertension 1995;26:801-807.
ABSTRACT | FULL TEXT  

Is White Coat Hypertension Associated With Arterial Disease or Left Ventricular Hypertrophy?
Cavallini et al.
Hypertension 1995;26:413-419.
ABSTRACT | FULL TEXT  

Blood Pressure Measurement in Childhood Epidemiological Studies
Gillman and Cook
Circulation 1995;92:1049-1057.
ABSTRACT | FULL TEXT  

Diminished Nocturnal Blood Pressure Decline and Lesion Site in Cerebrovascular Disease
Yamamoto et al.
Stroke 1995;26:829-833.
ABSTRACT | FULL TEXT  

Therapeutic Issues in the Evaluation and Treatment of the Hypertensive Patient: White Coat Hypertension and Once Daily Dosing of Antihypertensive Agents
Wilson
Journal of Pharmacy Practice 1992;5:106-114.
ABSTRACT  

COMPLICATIONS OF ""WHITE COAT"" VS. SUSTAINED HYPERTENSION
JWatch General 1989;1989:3-3.
FULL TEXT