White-Coat and Masked Hypertension Are Associated With Carotid Atherosclerosis in a General Population

On the basis of combined measurements of clinic blood pressure (CBP) and out-of-office blood pressure (BP), such as home blood pressure (HBP) and ambulatory BP, BP status can be divided into 4 categories: normotension (NT), whitecoat hypertension (WCHT), masked hypertension (MHT), and sustained hypertension (SHT). Although several authors have reported clear associations of MHT and SHT with cardiovascular disease, there is still uncertainty about the influence of WCHT on subclinical organ damage, such as carotid atherosclerosis, as well as on cardiovascular or renal disease. Present guidelines for the management of hypertension recommend assessment of subclinical arterial disease as an intermediate stage in the continuum of vascular disease among subjects at high risk of cardiovascular disease. Among several noninvasive screening tests of subclinical arterial disease, ultrasound examination of the carotid arteries with assessment of intima-media thickness (IMT) and atherosclerotic plaques has been clearly shown to be useful in predicting the future risks of coronary heart disease and stroke. In the present cross-sectional study, we evaluated the associations of WCHT, MHT, and SHT defined using CBP and HBP with carotid atherosclerosis evaluated using ultrasound examination in a general Japanese population. Background and Purpose—On the basis of combined measurements of clinic blood pressure (CBP) and home blood pressure (HBP), blood pressure status can be divided into normotension, white-coat hypertension (WCHT), masked hypertension (MHT), and sustained hypertension (SHT). Despite the clear impact of MHT and SHT on clinical and subclinical arterial disease, uncertainty about the influence of WCHT remains. The objective of this study was to investigate the associations of WCHT, MHT, and SHT with carotid atherosclerosis in a general population. Methods—This is a cross-sectional survey of 2915 community-dwelling Japanese aged ≥40 years. Normotension was defined as CBP<140/90 and HBP<135/85 mm Hg; WCHT, CBP≥140/90 and HBP<135/85 mm Hg; MHT, CBP<140/90 and HBP≥135/85 mm Hg; and SHT, CBP≥140/90 and HBP≥135/85 mm Hg. Mean intima-media thickness of carotid arteries was measured using a computer-automated system, and carotid stenosis was defined as diameter stenosis ≥30%. Results—There were 1374 subjects (47.1%) with normotension, 200 (6.9%) with WCHT, 639 (21.9%) with MHT, and 702 (24.1%) with SHT. The geometric average of mean intima-media thickness was significantly higher among subjects with WCHT (0.73 mm), MHT (0.77 mm), and SHT (0.77 mm) than those with normotension (0.67 mm; all P<0.001 versus normotension). Compared with normotension, all types of hypertension were also associated with increased likelihood of carotid stenosis (ageand sex-adjusted odds ratio, 2.36 [95% confidence interval, 1.27–4.37] for WCHT, 1.95 [1.25– 3.03] for MHT, and 3.02 [2.01–4.54] for SHT). These associations remained significant even after adjustment for other cardiovascular risk factors. Conclusions—WCHT, as well as MHT, and SHT were associated with carotid atherosclerosis in a general Japanese population. (Stroke. 2013;44:1512-1517.)