The prevalence of hypertension-associated cardiac damage was higher in white coat hypertension and masked hypertension compared to sustained normotension, supporting the need to measure blood pressure both in the office and at home when diagnosing and monitoring hypertension.
Key Findings
Results
White coat hypertension (WCHT) was associated with significantly higher odds of hypertension-associated cardiac damage compared to sustained normotension (SNT).
LVEF < 50% odds ratio for WCHT vs SNT: OR 1.83 (95% CI 1.17–2.86)
CACS ≥ 100 odds ratio for WCHT vs SNT: OR 1.58 (95% CI 1.19–2.11)
Study population consisted of 4115 individuals examined with office and home BP measurement, computed tomography, coronary computed tomography angiography, and echocardiography
WCHT is traditionally considered a lower-risk phenotype, but these findings indicate meaningful cardiac damage associated with it
Results
Masked hypertension (MHT) was associated with significantly higher odds of hypertension-associated cardiac damage compared to sustained normotension (SNT), with some of the largest effect sizes observed.
LVEF < 50% odds ratio for MHT vs SNT: OR 2.68 (95% CI 1.41–5.10)
CACS ≥ 100 odds ratio for MHT vs SNT: OR 2.15 (95% CI 1.37–3.38)
CACS ≥ 300 odds ratio for MHT vs SNT: OR 2.34 (95% CI 2.21–4.52)
MHT odds ratios for LVEF < 50% and CACS ≥ 100 were numerically higher than those observed for sustained hypertension (SHT) vs SNT
Results
Sustained hypertension (SHT) was associated with significantly higher odds of hypertension-associated cardiac damage compared to sustained normotension (SNT).
LVEF < 50% odds ratio for SHT vs SNT: OR 2.34 (95% CI 1.53–3.57)
CACS ≥ 100 odds ratio for SHT vs SNT: OR 1.52 (95% CI 1.14–2.02)
SHT served as one of two reference groups for comparative analyses alongside SNT
SHT odds ratios were generally comparable to or lower than those seen for MHT
Methods
The study used a comprehensive population-based design with 4115 individuals assessed by multiple imaging modalities to characterize cardiac damage across four BP phenotypes.
BP phenotypes examined: sustained normotension (SNT), white coat hypertension (WCHT), masked hypertension (MHT), and sustained hypertension (SHT)
Imaging modalities included computed tomography, coronary computed tomography angiography, and echocardiography
Cardiac damage outcomes assessed included CACS ≥ 100 and ≥ 300, Segment Involvement Score (SIS) ≥ 4, any significant (>50%) coronary stenosis, LVEF < 50%, E/e' ratio ≥ 14, and global longitudinal strain (GLS) > −17 (men) or > −18 (women)
BP was measured both in the office and at home to classify participants into phenotypes
Conclusions
The findings support measuring blood pressure both in the office and at home, and considering WCHT and MHT when assessing cardiovascular risk.
Both WCHT and MHT showed significantly elevated odds of cardiac damage relative to SNT
The authors conclude that 'WCHT and MHT should therefore be considered when assessing cardiovascular risk'
The authors recommend that 'BP should be measured both in the office and at home when diagnosing and monitoring hypertension'
MHT, which is only detectable with out-of-office BP measurement, showed some of the highest odds ratios for cardiac damage outcomes
What This Means
This research suggests that people whose blood pressure appears normal in a doctor's office but is high at home (called 'masked hypertension') and people whose blood pressure appears high in a doctor's office but is normal at home (called 'white coat hypertension') both have significantly more heart damage than people with consistently normal blood pressure. The study measured blood pressure in both settings in over 4,000 people and used advanced imaging techniques—including CT scans and echocardiograms—to look for signs of heart damage such as reduced pumping function, calcium buildup in coronary arteries, and coronary artery narrowing.
The findings are particularly notable for masked hypertension, which showed even higher odds of certain types of heart damage than sustained (consistently diagnosed) hypertension compared to sustained normotension. White coat hypertension, which has historically been regarded as a relatively benign condition, was also associated with meaningfully higher odds of reduced heart pumping function and coronary artery calcium buildup compared to people with consistently normal blood pressure.
This research suggests that relying solely on blood pressure measurements taken in a clinic setting is insufficient for accurately assessing a person's cardiovascular risk. Measuring blood pressure at home, in addition to the clinic, could help identify people with masked hypertension who might otherwise be missed, as well as better characterize the true risk associated with white coat hypertension. Both conditions warrant attention when evaluating heart health risks.