Department of Internal Medicine, School of Medical Sciences, State University of Campinas, SP Paulo, Brazil.
Pronto Socorro Cardiológico de Pernambuco (PROCAPE), University of Pernambuco, Recife, PE, Brazil.
J Hum Hypertens. 2024 Aug;38(8):595-602. doi: 10.1038/s41371-024-00930-5. Epub 2024 Jul 10.
The values used to define white-coat and masked blood pressure (BP) effects are usually arbitrary. This study aimed at investigating the accuracy of various cutoffs based on the differences (ΔBP) between office BP (OBP) and 24h-ambulatory BP monitoring (ABPM) to identify white-coat (WCH) and masked (MH) hypertension, which are phenotypes coupled with adverse prognosis. This cross-sectional study included 11,350 [Derivation cohort; 45% men, mean age = 55.1 ± 14.1 years, OBP = 132.1 ± 17.6/83.9 ± 12.5 mmHg, 24 h-ABPM = 121.6 ± 11.4/76.1 ± 9.6 mmHg, 25% using antihypertensive medications (AH)] and 7220 (Validation cohort; 46% men, mean age = 58.6 ± 15.1 years, OBP = 136.8 ± 18.7/87.6 ± 13.0 mmHg, 24 h-ABPM = 125.5 ± 12.6/77.7 ± 10.3 mmHg; 32% using AH) unique individuals who underwent 24 h-ABPM. We compared the sensitivity, specificity, positive and negative predictive values and area under the curve (AUC) of diverse ΔBP cutoffs to detect WCH (ΔsystolicBP/ΔdiastolicBP = 28/17, 20/15, 20/10, 16/11, 15/9, 14/9 mmHg and ΔsystolicBP = 13 and 10 mmHg) and MH (ΔsystolicBP/ΔdiastolicBP = -14/-9, -5/-2, -3/-1, -1/-1, 0/0, 2/2 mmHg and ΔsystolicBP = -5 and -3mmHg). The 20/15 mmHg cutoff showed the best AUC (0.804, 95%CI = 0.794-0.814) to detect WCH, while the 2/2 mmHg cutoff showed the highest AUC (0.741, 95%CI = 0.728-0.754) to detect MH in the Derivation cohort. Both cutoffs also had the best accuracy to detect WCH (0.767, 95%CI = 0.754-0.780) and MH (0.767, 95%CI = 0.750-0.784) in the Validation cohort. In secondary analyses, these cutoffs had the best accuracy to detect individuals with higher and lower office-than-ABPM grades in both cohorts. In conclusion, the 20/15 and 2/2 mmHg ΔBP cutoffs had the best accuracy to detect hypertensive patients with WCH and MH, respectively, and can serve as indicators of marked white-coat and masked BP effects derived from 24 h-ABPM.
用于定义白大衣效应和掩蔽性血压（BP）效应的数值通常是任意的。本研究旨在通过比较办公室血压（OBP）与 24 小时动态血压监测（ABPM）之间的差值（ΔBP）的各种截断值，以识别白大衣（WCH）和掩蔽性（MH）高血压，这些表型与不良预后相关。这项横断面研究包括 11350 名（推导队列；45%为男性，平均年龄 55.1±14.1 岁，OBP 为 132.1±17.6/83.9±12.5mmHg，24 小时 ABPM 为 121.6±11.4/76.1±9.6mmHg，25%使用抗高血压药物（AH））和 7220 名（验证队列；46%为男性，平均年龄 58.6±15.1 岁，OBP 为 136.8±18.7/87.6±13.0mmHg，24 小时 ABPM 为 125.5±12.6/77.7±10.3mmHg；32%使用 AH）接受 24 小时 ABPM 的个体。我们比较了不同 ΔBP 截断值检测 WCH（Δ收缩压/Δ舒张压=28/17、20/15、20/10、16/11、15/9、14/9mmHg 和 Δ收缩压=13 和 10mmHg）和 MH（Δ收缩压/Δ舒张压=-14/-9、-5/-2、-3/-1、-1/-1、0/0、2/2mmHg 和 Δ收缩压=-5 和-3mmHg）的敏感性、特异性、阳性和阴性预测值以及曲线下面积（AUC）。20/15mmHg 截断值在推导队列中显示出检测 WCH 的最佳 AUC（0.804，95%CI=0.794-0.814），而 2/2mmHg 截断值在验证队列中显示出检测 MH 的最高 AUC（0.741，95%CI=0.728-0.754）。这两个截断值在推导队列中也具有检测 WCH（0.767，95%CI=0.754-0.780）和 MH（0.767，95%CI=0.750-0.784）的最佳准确性。在二次分析中，这两个截断值在两个队列中都具有检测 OBP 比 ABPM 分级更高和更低的个体的最佳准确性。总之，20/15 和 2/2mmHg ΔBP 截断值在检测 WCH 和 MH 高血压患者方面具有最佳的准确性，可作为源于 24 小时 ABPM 的明显白大衣和掩蔽性 BP 效应的指标。
