Masked and white coat hypertension, the double trouble of large arteries: A systematic review and meta-analysis

J Clin Hypertens (Greenwich). 2020 May;22(5):802-811. doi: 10.1111/jch.13876. Epub 2020 May 1.

Abstract

Arterial damage of large arteries, addressed as c-f PWV, is recognized as independent predictor for future cardiovascular disease. The aim of this study was to systematically investigate the association of the four hypertension phenotypes with carotid-femoral pulse wave velocity (c-f PWV), in untreated patients. PubMed and Cochrane Library were searched to identify studies comparing c-f PWV levels between normotensives, sustained hypertensives, white-coat hypertensives (WCH), and masked hypertensives (MH). Meta-analysis was performed to compare the difference c-f PWV levels between these groups. Newcastle-Ottawa quality assessment scale for cross-sectional studies was used to assess study quality. MH and WCH patients had significantly increased c-f PWV values compared to the normotensive groups (d = 0.96 m/s, 95% CI: 0.49-1.42; I2 = 85%, P < .01 for MH and d = 0.85 m/s, 95% CI: 0.48-1.22; I2 = 89%, for WCH). Moreover, the sustained hypertensive population was found to have significantly increased values of c-f PWV compared to MH (d = -0.70 m/s, 95% CI: -0.87 to -0.54; I2 = 12%, P = .33) but not compared to WCH population (d = -0.75 m/s, 95% CI: -1.52-0.02; I2 = 96%,). Finally, there was no significant difference between MH and WCH population (d = 0.06 m/s, 95% CI: -1.04 to 1.15; I2 = 96%,). MH and WCH population may have increased values of c-f PWV compared to the normotensive group. These results demonstrate that these phenotypes are not clinically innocent, in the untreated population.

Keywords: arterial stiffness; masked hypertension; meta-analysis; pulse wave velocity; systematic review; white-coat hypertension.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Arteries
  • Cross-Sectional Studies
  • Humans
  • Masked Hypertension / diagnosis
  • Masked Hypertension / epidemiology
  • Pulse Wave Analysis
  • White Coat Hypertension* / diagnosis
  • White Coat Hypertension* / epidemiology