Impact of Clinic Blood Pressure Target on the Prevalence and Predictors of Masked Uncontrolled Hypertension and White-Coat Uncontrolled Hypertension.

backgroundIdentifying masked uncontrolled hypertension (MUCH) and white-coat uncontrolled hypertension (WUCH) without ambulatory blood pressure (ABP) monitoring is challenging. Recent literature advocates intensive blood pressure (BP) control, but standard guidelines still suggest a clinic BP threshold of ≥ 149/90 mmHg to diagnose hypertension. This study explored the impact of different clinic BP targets on the prevalence and predictors of MUCH and WUCH.

methodsThis multicenter prospective cohort study included 1,601 patients with hypertension from the Korean Ambulatory Blood Pressure registry, all with valid ABP records. Two clinic BP targets were evaluated: an intensive target (< 130/80 mmHg) and a conventional target (< 140/90 mmHg). Controlled hypertension was defined as a 24-hour mean ABP < 130/80 mmHg in patients treated with antihypertensive drugs who had a clinic BP below these targets.

resultsThe prevalence of MUCH decreased significantly with the intensive target (15.5%) versus the conventional target (45.8%). In contrast, the prevalence of WUCH increased only marginally with the intensive targets. Most patients with MUCH (75.9%) had a clinic BP between 130/80 mmHg and 139/89 mmHg when MUCH was classified using the conventional target. For predicting MUCH, factors such as angiotensin-converting enzyme inhibitor use, body mass index, left ventricular mass index (LVMI), and use of ≥ 2 antihypertensive drugs were significant under the intensive target, whereas clinic BP, LVMI, alcohol intake, stroke history, and use of ≥ 2 antihypertensive drugs were relevant under the conventional target.

conclusionAdopting the intensive clinic BP target (< 130/80 mmHg) notably reduced the prevalence of MUCH, with a slight increase in WUCH, offering a more accurate assessment of BP control than the conventional target.