Prevalence of masked uncontrolled hypertension according to the number of office blood pressure measurements

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Vinyoles, M. Camafort, M. Domenech, A. Coca, J. Sobrino" "autores" => array:6 [ 0 => array:4 [ "nombre" => "E." "apellidos" => "Vinyoles" "email" => array:1 [ 0 => "23561evb@comb.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Camafort" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Domenech" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Coca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "J." "apellidos" => "Sobrino" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 5 => array:1 [ "colaborador" => "for the ESTHEN group investigators" ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Centre d’Atenció Primària La Mina, Sant Adrià de Besòs, Universitat de Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unitat d’Hipertensió i Risc Vascular, Departament de Medicina Interna, Institut de Medicina i Dermatologia, Hospital Clínic (IDIBAPS), Universitat de Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unitat d’Hipertensió, Fundació Hospital de l’Esperit Sant, Santa Coloma de Gramenet, Universitat de Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prevalencia de hipertensión arterial enmascarada no controlada de acuerdo con el número de medidas de la tensión arterial en consulta" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1378 "Ancho" => 1628 "Tamanyo" => 131655 ] ] "descripcion" => array:1 [ "en" => "Prevalences [95% CI] of masked uncontrolled hypertension (MUCH) considering the four definitions based in successive office blood pressure readings." ] ] ] "textoCompleto" => "IntroductionMasked uncontrolled hypertension (MUCH) is defined as hypertensive patients receiving antihypertensive treatment with controlled office blood pressure (BP) but high ambulatory BP.<a class="elsevierStyleCrossRefs" href="#bib0110">1–3</a> These are hypertensive patients in whom ignorance of poor ambulatory BP control results in a high probability that optimal BP control is delayed for too long.The diagnosis of MUCH requires a record of 24-h ambulatory BP monitoring (ABPM), although it may be detected using self-measured BP monitoring (HBPM). The reported prevalence of MUCH varies, although many studies are not comparable as they include differing samples of hypertensive patients or use different methodologies. A prevalence of 13.1% of all treated hypertensive patients has been reported in Spanish hypertensive units.<a class="elsevierStyleCrossRef" href="#bib0125">4</a> A Japanese study using self-measured blood pressure found a prevalence of 19%.<a class="elsevierStyleCrossRef" href="#bib0130">5</a> When only hypertensive patients with good office BP control are evaluated, more than a third may have MUCH as measured by ABPM,<a class="elsevierStyleCrossRefs" href="#bib0135">6–8</a> although our experience suggests the prevalence may be as high as 50%.<a class="elsevierStyleCrossRef" href="#bib0150">9</a> Banegas et al. found a prevalence of MUCH of 31.1%, significantly higher in males, patients with borderline clinic BP, and patients at high cardiovascular risk.<a class="elsevierStyleCrossRef" href="#bib0155">10</a> However, other studies have found a prevalence of only 13.4% in this group of patients.<a class="elsevierStyleCrossRef" href="#bib0160">11</a>This variability between studies may be explained, in part, by the different definitions of good ambulatory BP control, according to the selection of mean 24-h or mean daytime blood pressure to define MUCH. Moreover, the methodology for measuring office BP may also explain the differences in the reported prevalence of MUCH. Therefore, the aim of this study was to determine whether the prevalence of MUCH varied according to the number of office BP readings, and to describe which pattern of office BP readings was most closely associated with subclinical organ damage.MethodsWe carried out an observational, cross-sectional, multicenter study in 33 Spanish hospital-based hypertension units, involving 35 investigators. By means of convenience sampling, hypertensive patients aged >18 years attended by the units between January and June 2012 who had been receiving stable antihypertensive medication for the previous three months and who gave written informed consent to participate were included. Night shift workers, patients with arrhythmias (atrial fibrillation or baseline heart rate>100 beats per minute) or arm circumference>40cm were excluded. All subjects included underwent a history and physical examination and 6 office BP readings at baseline. The readings were made one minute apart with a validated automatic sphygmomanometer in a sitting position after five minutes of rest. A large cuff was used when necessary.Also at baseline, each patient underwent 24-h ABPM (SpaceLabs 90207/90217, Richmond, Washington, USA) on a working day, with readings scheduled every 20min through the 24-h period. Periods of activity and sleep were adjusted to those reported by the patients. An obese cuff was used when indicated. ABPM recordings of <24h, with <70% of valid readings, or with periods of >1h without a reading were rejected. Blood samples for blood and urine analysis, and an electrocardiogram were carried out. The design and carrying out of the study were approved by the Research Ethics Committee of the Catalan Foundation of Hospitals.The variables analyzed included gender, age, body mass index, waist circumference, heart rate, office and ambulatory BP, a diagnosis of diabetes mellitus (defined as patients with ≥2 episodes of fasting glycaemia ≥126mg/dl, according to American Diabetes Association criteria<a class="elsevierStyleCrossRef" href="#bib0165">12</a>), hypercholesterolemia (total cholesterol >190mg/dl, or LDL cholesterol >115mg/dl, or HDL cholesterol <40mg/dl in males or <46mg/dl in women, or use of lipid lowering drugs<a class="elsevierStyleCrossRef" href="#bib0170">13</a>), active smoking (defined as regular daily consumption of any type of tobacco), family history of premature cardiovascular disease (<55 years in men, <65 years in women), alcohol consumption >30g/day, antihypertensive therapy and associated cardiovascular disease: stroke, coronary disease, chronic kidney disease [defined by estimated glomerular filtration rate according to Levey's simplified formula, MDRD <60ml/min],<a class="elsevierStyleCrossRef" href="#bib0175">14</a> microalbuminuria (albumin-to-creatinine ratio >30mg/g in males or >22mg/g in females), peripheral artery disease and heart failure. Electrocardiographic left ventricular hypertrophy (LVH) was defined using the Cornell index (males: RaVL+SV3>2.8mV; females: RaVL+SV3>2.0mV) or the Sokolow-Lyon index (SV1+RV5 o V6>3.5mV) or by RaVL voltage>6mV.MUCH was defined as office BP <140mmHg (systolic) and <90mmHg (diastolic) and mean 24-h ABPM ≥130 or ≥80mmHg, respectively. Four successive mean office BP values were selected: the means of the 1st, 2nd and 3rd readings (P123), the 2nd, 3rd and 4th readings (P234), the 3rd, 4th and 5th readings (P345), and the 4th, 5th and 6th readings (P456), which provided four possible measurements of MUCH (MUCH123, MUCH234, MUCH345, MUCH456).Descriptive statistics are presented as means (standard deviation, SD) or as numbers (percentage). Assuming a prevalence of MUCH of 23%,<a class="elsevierStyleCrossRef" href="#bib0180">15</a> with a 95% confidence interval (CI) of ≤0.08 (8%), a total of 426 subjects were estimated to be necessary for analysis of the main objective. All results were expressed with 95% CI. Pearson's coefficient was used to evaluate the correlation between ambulatory blood pressure and the 4 definitions of masked uncontrolled hypertension. Statistical significance was set at p<0.05 (two-tailed). The analyses were performed using Stata/SE version 11.1 for Windows (StataCorp, LP).ResultsA total of 503 hypertensive patients were recruited, of whom 498 were finally included. Five patients were excluded due to noncompliance with selection criteria (1 case), lack of information on ABPM (2 cases), length of ABPM<22h (1 case), or only 66% of valid ABPM readings (1 case).The baseline characteristics of the sample are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The mean values of systolic and diastolic BP were progressively lower in each successive office BP reading (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia>Mean (SD) office BP measurements were: (P123) 141 (18)/82 (11); (P234) 139 (17)/81 (11); (P345) 138 (17)/81 (11) and (P456) 137 (16)/80 (10) mmHg. Based on office readings, BP control (<140/<90mmHg) was (P123) 43.98%, (P234) 51.2%, (P345) 53.01% and (P456) 55.22%. Control was observed in 200 patients using the first office BP reading (P1), 187 of them had also controlled the successive second reading (P1 and P2), 93.5 [90.1–96.9] %, and 181 subjects had good control of first, second and third successive readings (P1 and P2 and P3), representing a 90.5 [86.4–94.6]% of those 200 patients.The prevalence of MUCH on the whole sample according to the various groups of office BP readings is shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the Pearson correlations between 24-h ABPM and the means of the four groups of office BP readings. No significant association between the different definitions of MUCH and LVH (by electrocardiogram) or microalbuminuria was found (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>DiscussionCorrect diagnosis of hypertension currently requires the combined evaluation of office and ambulatory BP. This is particularly evident when a diagnosis of white-coat hypertension is made. However, the diagnosis of masked hypertension also requires an accurate assessment of office BP. The varying prevalences of masked hypertension found in different studies are related not only to variations in patient samples evaluated in each study, but also to aspects of the measurement of office BP. For example, the characteristics of BP measured repeatedly in a single clinic visit could be predictive of clinical differences in BP between repeated home and clinic measurements.<a class="elsevierStyleCrossRef" href="#bib0185">16</a> The interesting study of Banegas et al<a class="elsevierStyleCrossRef" href="#bib0155">10</a> included a high number of subjects. They performed only two office BP measurements and they found a MUCH prevalence of 31%. Considering the results of our study, it could be assumed that, if more BP readings had been made, the prevalence of MUCH would have been even greater. Nevertheless, the differences between the prevalence of MUCH found by Banegas et al. and the prevalence in our study could be explained by differences between the two samples. Our sample is recruited just from a specialized hospital setting, with higher prevalence of associated cardiovascular disease and probably with longer duration of hypertension, more frequent evaluations of ambulatory blood pressure, and more number and higher doses of antihypertensive drugs.Our results show that the method of measuring office BP influences the diagnosis of MUCH. Office BP was measured under optimal conditions by doctors and nurses from various specialized Spanish hypertension units. However, office BP decreased gradually in successive BP readings, even after initial rest and in the context of the baseline conditions of an experimental study. There was a reduction of up to 7mmHg for systolic BP and up to 3.6mmHg for diastolic between the first and sixth readings. Therefore, the prevalence of MUCH ranged between 14.5% in the first reading to 21.1% in the sixth reading in our study. Pearson correlations between ambulatory BP and each of the four groups of means office BP were quite similar. However, the best correlation was with diastolic 24-h ABPM and the mean diastolic office BP of the last three readings.Thus, it seems that the inclusion or not of the first office BP readings is crucial in defining MUCH, especially the first reading. Most patients in our study had an alert reaction after the first office BP reading, despite the prior rest period. This alert reaction lessened progressively in successive readings. These reactions were similar when office BP was measured by physicians or nurses. However, the results might have differed if readings had been made using automatic BP monitors, without any medical intervention. That makes office BP values closer to the mean daytime BP (ABPM or HBPM).<a class="elsevierStyleCrossRef" href="#bib0190">17</a> However, it appears that the first BP readings are also higher in this case.<a class="elsevierStyleCrossRef" href="#bib0195">18</a> For example, Myers et al. found a BP reduction between the first and sixth automatic office measurements: 14mmHg for systolic BP and 5mmHg for diastolic BP.<a class="elsevierStyleCrossRef" href="#bib0200">19</a> And in our experience, an alert reaction is even detected in the first self-measurement by the patient, with an increase of systolic BP.<a class="elsevierStyleCrossRef" href="#bib0205">20</a>None of the four groups of BP readings was significantly associated with subclinical organ damage, particularly with urinary albumin excretion or electrocardiographic criteria for left ventricular hypertrophy. It may be that a larger sample size would be needed to detect an association of this type, and this is a limitation of the study. Another potential limitation is the variability of BP measurement given the many investigators and participating centers.It is known that the masked phenomena are higher in treated hypertensive patients than in untreated. This could be because there are other uncontrolled BP measurement and treatment aspects that could influence the office BP variability and therefore may affect the prevalence of MUCH: the time of office BP measurement, the time of taking the antihypertensive medication, the effect of postprandial hypotension in the elderly, the antihypertensive treatment nighttime noncompliance when ABPM is performed or unrecognized consumption of other drugs or alcohol.<a class="elsevierStyleCrossRef" href="#bib0210">21</a> However, we suggest that this variability reflects usual clinical practice and that our results are robust.ConclusionsIn conclusion, our results suggest that the first two office BP readings should routinely be discarded and a mean value should be taken from subsequent readings, except for patients whose first reading is <140/90mmHg, because successive readings were even lower in 90% of cases.Conflicts of interestThere are no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres575598" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec592288" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xpalclavsec592287" "titulo" => "Abbreviations" ] 3 => array:3 [ "identificador" => "xres575597" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 4 => array:2 [ "identificador" => "xpalclavsec592289" "titulo" => "Palabras clave" ] 5 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 6 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 7 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 11 => array:2 [ "identificador" => "xack193982" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-03-02" "fechaAceptado" => "2015-06-17" "PalabrasClave" => array:2 [ "en" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec592288" "palabras" => array:3 [ 0 => "Masked hypertension" 1 => "Masked uncontrolled hypertension" 2 => "Office blood pressure measurement" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abbreviations" "identificador" => "xpalclavsec592287" "palabras" => array:5 [ 0 => "ABPM" 1 => "BP" 2 => "HBPM" 3 => "LVH" 4 => "MUCH" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec592289" "palabras" => array:3 [ 0 => "Hipertensión enmascarada" 1 => "Hipertensión arterial no controlada" 2 => "Medición de la presión arterial en consulta" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "Introduction and objectivesThe reported prevalence of masked uncontrolled hypertension (MUCH) varies because many studies are not comparable as they use different measurement methodologies. To evaluate the influence of the number of office blood pressure readings on the prevalence of MUCH we conducted a cross-sectional, multicenter study in treated hypertensive patients. Patients and methodsWe carried out an observational, cross-sectional, multicenter study in 33 Spanish hospital-based hypertension units, involving 35 investigators and 12 Autonomous Communities. Six blood pressure readings and a 24-h ambulatory blood pressure monitoring were performed in treated hypertensive patients. The means of the first 3 readings (P123), the 2nd, 3rd and 4th readings (P234), the 3rd, 4th and 5th readings (P345) and the last 3 readings (P456) were compared with mean 24-h blood pressure. MUCH was defined as office blood pressure <140/90mmHg and 24-h blood pressure ≥130/80mmHg, considering the first 3 readings (MUCH123), the 2nd, 3rd and 4th readings (MUCH234), the 3rd, 4th and 5th readings (MUCH345) and the last 3 readings (MUCH456). ResultsWe included 498 hypertensive patients. Mean (standard deviation) office blood pressure measurements were: (P123) 141(18)/82(11); (P234) 139(17)/81(11); (P345) 138(17)/81(11) and (P456) 137(16)/80(10) mmHg. Mean 24-h blood pressure was 127(13.8)/75(9.5) mmHg. The correlation coefficients between ambulatory and office systolic/diastolic blood pressure were (P123):0.48/0.50; (P234):0.50/0.52; (P345):0.50/0.54; and (P456):0.50/0.55 (p<0.001, all). The prevalences of MUCH123, MUCH234, MUCH345 and MUCH456 were 14.5%, 18.9%, 19.5% and 21.1%, respectively. ConclusionsThe prevalence of MUCH diagnosis depends on the serial office blood pressure readings, being much higher for the last three blood pressure readings. Discarding the first and second office blood pressure measures seems to be the most accurate method for diagnosing MUCH." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "Introducción y objetivosLos datos sobre prevalencia de hipertensión arterial enmascarada no controlada (HTAE) son muy variables, ya que los registros obtenidos en diferentes estudios no son comparables al emplear diferentes métodos de medición. Se llevó a cabo un estudio transversal y multicéntrico en pacientes hipertensos tratados para evaluar la influencia de la cantidad de lecturas de la presión arterial en consulta sobre la prevalencia de la HTAE. Pacientes y métodosSe realizó un estudio observacional, transversal y multicéntrico en 33 unidades de hipertensión en hospitales españoles, con la participación de 35 investigadores y 12 comunidades autónomas. Se realizaron 6 lecturas de la presión arterial y un control de la presión arterial ambulatoria de 24h en pacientes hipertensos tratados. Se compararon las medias de las 3 primeras lecturas (P123), de las lecturas 2, 3 y 4 (P234), de las lecturas 3, 4 y 5 (P345) y de las 3 últimas lecturas (P456) con la media de la presión arterial a las 24h. Teniendo en cuenta las 3 primeras lecturas (HTAE123), las lecturas segunda, tercera y cuarta (HTAE234), tercera, cuarta y quinta (HTAE345) y las últimas 3 lecturas (HTAE456); definimos la HTAE como una presión arterial en consulta <140/90mmHg y una presión arterial de 24h ≥130/80mmHg. ResultadosSe incluyeron 498 pacientes hipertensos. La media de las mediciones (desviación estándar) de presión arterial en consulta fueron: (P123) 141 (18)/82 (11); (P234) 139 (17)/81 (11); (P345) 138 (17)/81 (11) y (P456) 137 (16)/80 (10) mmHg. La presión arterial media a las 24h fue de 127 (13.8)/75 (9.5) mmHg. Los coeficientes de correlación entre presión sistólica/presión diastólica ambulatoria y en consulta fueron (P123): 0.48/0.50; (P234): 0.50/0.52; (P345): 0.50/0.54; y (P456): 0.50/0.55 (p<0.001 de todos). Las prevalencias de HTAE123, HTAE234, HTAE345 y HTAE456 fueron 14.5%, 18.9%, 19.5% y 21.1%, respectivamente. ConclusionesLa prevalencia de diagnóstico de HTAE depende de las series de lecturas de la presión arterial en consulta, siendo esta mucho más alta en las 3 últimas lecturas. Si descartamos la primera y segunda lecturas, la medida de la presión arterial en consulta parece ser el método más preciso para el diagnóstico de la HTAE." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1379 "Ancho" => 1575 "Tamanyo" => 145696 ] ] "descripcion" => array:1 [ "en" => "Mean (standard deviation) of the 6 office blood pressure readings." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1378 "Ancho" => 1628 "Tamanyo" => 131655 ] ] "descripcion" => array:1 [ "en" => "Prevalences [95% CI] of masked uncontrolled hypertension (MUCH) considering the four definitions based in successive office blood pressure readings." ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "SD: standard deviation; BMI: body mass index; BP: blood pressure" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Women \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">206 (41.37) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age, years; mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 (13.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Family history of premature cardiovascular disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78 (15.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">BMI (kg/m2); mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29.1 (4.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Waist circumference (cm); mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99.1 (12.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Smoking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61 (12.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Alcohol consumption>30g/day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (2.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Type 2 diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">130 (26.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Hypercholesterolemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">320 (64.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Electrocardiographic left ventricular hypertrophy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (4.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Chronic kidney disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 (18.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Associated cardiovascular disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">146 (29.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Office BP (mmHg); mean of all readings (SD)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Systolic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">139 (16.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diastolic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81 (10.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">24-h BP (mmHg); mean (SD)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Systolic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">127 (13.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diastolic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 (9.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Daytime BP (mmHg); mean (SD)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Systolic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">131 (14.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diastolic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78 (10.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Night-time BP (mmHg); mean (SD)</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Systolic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">120 (15.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diastolic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69 (9.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Office heart rate (beats per minute); mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 (11.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Night-time HR (beats per minute); mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67 (9.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab939436.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Sociodemographic and clinical characteristics of subjects. Values are numbers (percentage) unless otherwise indicated (n=498)." ] ] 3 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "OBP123: definition based in the mean of the 1st, 2nd and 3rd office blood pressure readings; OBP234: idem of 2nd, 3rd and 4th readings; OBP345: idem of 3rd, 4th and 5th readings; OBP456: idem of 4th, 5th and 6th readings." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OBP123 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OBP234 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OBP345 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OBP456 \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">24h systolic blood pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">24h diastolic blood pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.55 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab939438.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Pearson's correlations between ambulatory blood pressure and the four different office blood pressure (OBP) measurements, all p<0.001." ] ] 4 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "MUCH123: definition based in the mean of the 1st, 2nd and 3rd office blood pressure readings; MUCH234: idem of 2nd, 3rd and 4th readings; MUCH345: idem of 3rd, 4th and 5th readings; MUCH456: idem of 4th, 5th and 6th readings; OR: odds ratio; CI: confidence interval." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">LVH OR [95% CI] \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Microalbuminuria OR [95% CI] \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">MUCH123 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.10 [0.65–1.84] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.60 [0.27–1.33] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">MUCH234 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.10 [0.69–1.74] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.84 [0.43–1.61] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">MUCH345 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.05 [0.66–1.66] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.73 [0.37–1.43] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">MUCH456 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.08 [0.69–1.70] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.83 [0.44–1.57] \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab939437.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Association between the four definitions of masked uncontrolled hypertension (MUCH) and electrocardiographic left ventricular hypertrophy (LVH) and microalbuminuria." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0110" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic value of white-coat and masked hypertension diagnosed by ambulatory monitoring in initially untreated subjects: an updated meta analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.D. 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The authors thank Albert Cobos and Salvador Bergoñon from SAALIG, for their important contribution to the statistical analysis. The logistic elements of the study were funded by Menarini, S.A. (Spain)." "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/00142565/0000021500000008/v1_201511010014/S0014256515001903/v1_201511010014/en/main.assets" "Apartado" => array:4 [ "identificador" => "1062" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Originales" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00142565/0000021500000008/v1_201511010014/S0014256515001903/v1_201511010014/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256515001903?idApp=WRCEE"]

Estadísticas

Original article

Prevalence of masked uncontrolled hypertension according to the number of office blood pressure measurements

Prevalencia de hipertensión arterial enmascarada no controlada de acuerdo con el número de medidas de la tensión arterial en consulta

E. Vinyolesa,

Autor para correspondencia

23561evb@comb.cat

Corresponding author.

, M. Camafortb, M. Domenechb, A. Cocab, J. Sobrinoc, for the ESTHEN group investigators

a Centre d’Atenció Primària La Mina, Sant Adrià de Besòs, Universitat de Barcelona, Spain

b Unitat d’Hipertensió i Risc Vascular, Departament de Medicina Interna, Institut de Medicina i Dermatologia, Hospital Clínic (IDIBAPS), Universitat de Barcelona, Spain

c Unitat d’Hipertensió, Fundació Hospital de l’Esperit Sant, Santa Coloma de Gramenet, Universitat de Barcelona, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Masked uncontrolled hypertension &#40;MUCH&#41; is defined as hypertensive patients receiving antihypertensive treatment with controlled office blood pressure &#40;BP&#41; but high ambulatory BP&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">1&#8211;3</span></a> These are hypertensive patients in whom ignorance of poor ambulatory BP control results in a high probability that optimal BP control is delayed for too long&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The diagnosis of MUCH requires a record of 24-h ambulatory BP monitoring &#40;ABPM&#41;&#44; although it may be detected using self-measured BP monitoring &#40;HBPM&#41;&#46; The reported prevalence of MUCH varies&#44; although many studies are not comparable as they include differing samples of hypertensive patients or use different methodologies&#46; A prevalence of 13&#46;1&#37; of all treated hypertensive patients has been reported in Spanish hypertensive units&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a> A Japanese study using self-measured blood pressure found a prevalence of 19&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a> When only hypertensive patients with good office BP control are evaluated&#44; more than a third may have MUCH as measured by ABPM&#44;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">6&#8211;8</span></a> although our experience suggests the prevalence may be as high as 50&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a> Banegas et al&#46; found a prevalence of MUCH of 31&#46;1&#37;&#44; significantly higher in males&#44; patients with borderline clinic BP&#44; and patients at high cardiovascular risk&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a> However&#44; other studies have found a prevalence of only 13&#46;4&#37; in this group of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">This variability between studies may be explained&#44; in part&#44; by the different definitions of good ambulatory BP control&#44; according to the selection of mean 24-h or mean daytime blood pressure to define MUCH&#46; Moreover&#44; the methodology for measuring office BP may also explain the differences in the reported prevalence of MUCH&#46; Therefore&#44; the aim of this study was to determine whether the prevalence of MUCH varied according to the number of office BP readings&#44; and to describe which pattern of office BP readings was most closely associated with subclinical organ damage&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We carried out an observational&#44; cross-sectional&#44; multicenter study in 33 Spanish hospital-based hypertension units&#44; involving 35 investigators&#46; By means of convenience sampling&#44; hypertensive patients aged &#62;18 years attended by the units between January and June 2012 who had been receiving stable antihypertensive medication for the previous three months and who gave written informed consent to participate were included&#46; Night shift workers&#44; patients with arrhythmias &#40;atrial fibrillation or baseline heart rate<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>100 beats per minute&#41; or arm circumference<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>cm were excluded&#46; All subjects included underwent a history and physical examination and 6 office BP readings at baseline&#46; The readings were made one minute apart with a validated automatic sphygmomanometer in a sitting position after five minutes of rest&#46; A large cuff was used when necessary&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Also at baseline&#44; each patient underwent 24-h ABPM &#40;SpaceLabs 90207&#47;90217&#44; Richmond&#44; Washington&#44; USA&#41; on a working day&#44; with readings scheduled every 20<span class="elsevierStyleHsp" style=""></span>min through the 24-h period&#46; Periods of activity and sleep were adjusted to those reported by the patients&#46; An obese cuff was used when indicated&#46; ABPM recordings of &#60;24<span class="elsevierStyleHsp" style=""></span>h&#44; with &#60;70&#37; of valid readings&#44; or with periods of &#62;1<span class="elsevierStyleHsp" style=""></span>h without a reading were rejected&#46; Blood samples for blood and urine analysis&#44; and an electrocardiogram were carried out&#46; The design and carrying out of the study were approved by the Research Ethics Committee of the Catalan Foundation of Hospitals&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The variables analyzed included gender&#44; age&#44; body mass index&#44; waist circumference&#44; heart rate&#44; office and ambulatory BP&#44; a diagnosis of diabetes mellitus &#40;defined as patients with &#8805;2 episodes of fasting glycaemia &#8805;126<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; according to American Diabetes Association criteria<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a>&#41;&#44; hypercholesterolemia &#40;total cholesterol &#62;190<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; or LDL cholesterol &#62;115<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; or HDL cholesterol &#60;40<span class="elsevierStyleHsp" style=""></span>mg&#47;dl in males or &#60;46<span class="elsevierStyleHsp" style=""></span>mg&#47;dl in women&#44; or use of lipid lowering drugs<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a>&#41;&#44; active smoking &#40;defined as regular daily consumption of any type of tobacco&#41;&#44; family history of premature cardiovascular disease &#40;&#60;55 years in men&#44; &#60;65 years in women&#41;&#44; alcohol consumption &#62;30<span class="elsevierStyleHsp" style=""></span>g&#47;day&#44; antihypertensive therapy and associated cardiovascular disease&#58; stroke&#44; coronary disease&#44; chronic kidney disease &#91;defined by estimated glomerular filtration rate according to Levey&#39;s simplified formula&#44; MDRD &#60;60<span class="elsevierStyleHsp" style=""></span>ml&#47;min&#93;&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">14</span></a> microalbuminuria &#40;albumin-to-creatinine ratio &#62;30<span class="elsevierStyleHsp" style=""></span>mg&#47;g in males or &#62;22<span class="elsevierStyleHsp" style=""></span>mg&#47;g in females&#41;&#44; peripheral artery disease and heart failure&#46; Electrocardiographic left ventricular hypertrophy &#40;LVH&#41; was defined using the Cornell index &#40;males&#58; RaVL<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>SV3<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>2&#46;8<span class="elsevierStyleHsp" style=""></span>mV&#59; females&#58; RaVL<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>SV3<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>2&#46;0<span class="elsevierStyleHsp" style=""></span>mV&#41; or the Sokolow-Lyon index &#40;SV1<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RV5 o V6<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>3&#46;5<span class="elsevierStyleHsp" style=""></span>mV&#41; or by RaVL voltage<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>mV&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">MUCH was defined as office BP &#60;140<span class="elsevierStyleHsp" style=""></span>mmHg &#40;systolic&#41; and &#60;90<span class="elsevierStyleHsp" style=""></span>mmHg &#40;diastolic&#41; and mean 24-h ABPM &#8805;130 or &#8805;80<span class="elsevierStyleHsp" style=""></span>mmHg&#44; respectively&#46; Four successive mean office BP values were selected&#58; the means of the 1st&#44; 2nd and 3rd readings &#40;P<span class="elsevierStyleInf">123</span>&#41;&#44; the 2nd&#44; 3rd and 4th readings &#40;P<span class="elsevierStyleInf">234</span>&#41;&#44; the 3rd&#44; 4th and 5th readings &#40;P<span class="elsevierStyleInf">345</span>&#41;&#44; and the 4th&#44; 5th and 6th readings &#40;P<span class="elsevierStyleInf">456</span>&#41;&#44; which provided four possible measurements of MUCH &#40;MUCH<span class="elsevierStyleInf">123</span>&#44; MUCH<span class="elsevierStyleInf">234</span>&#44; MUCH<span class="elsevierStyleInf">345</span>&#44; MUCH<span class="elsevierStyleInf">456</span>&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Descriptive statistics are presented as means &#40;standard deviation&#44; SD&#41; or as numbers &#40;percentage&#41;&#46; Assuming a prevalence of MUCH of 23&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a> with a 95&#37; confidence interval &#40;CI&#41; of &#8804;0&#46;08 &#40;8&#37;&#41;&#44; a total of 426 subjects were estimated to be necessary for analysis of the main objective&#46; All results were expressed with 95&#37; CI&#46; Pearson&#39;s coefficient was used to evaluate the correlation between ambulatory blood pressure and the 4 definitions of masked uncontrolled hypertension&#46; Statistical significance was set at <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 &#40;two-tailed&#41;&#46; The analyses were performed using Stata&#47;SE version 11&#46;1 for Windows &#40;StataCorp&#44; LP&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">A total of 503 hypertensive patients were recruited&#44; of whom 498 were finally included&#46; Five patients were excluded due to noncompliance with selection criteria &#40;1 case&#41;&#44; lack of information on ABPM &#40;2 cases&#41;&#44; length of ABPM<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>22<span class="elsevierStyleHsp" style=""></span>h &#40;1 case&#41;&#44; or only 66&#37; of valid ABPM readings &#40;1 case&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The baseline characteristics of the sample are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The mean values of systolic and diastolic BP were progressively lower in each successive office BP reading &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Mean &#40;SD&#41; office BP measurements were&#58; &#40;P<span class="elsevierStyleInf">123</span>&#41; 141 &#40;18&#41;&#47;82 &#40;11&#41;&#59; &#40;P<span class="elsevierStyleInf">234</span>&#41; 139 &#40;17&#41;&#47;81 &#40;11&#41;&#59; &#40;P<span class="elsevierStyleInf">345</span>&#41; 138 &#40;17&#41;&#47;81 &#40;11&#41; and &#40;P<span class="elsevierStyleInf">456</span>&#41; 137 &#40;16&#41;&#47;80 &#40;10&#41; mmHg&#46; Based on office readings&#44; BP control &#40;&#60;140&#47;&#60;90<span class="elsevierStyleHsp" style=""></span>mmHg&#41; was &#40;P<span class="elsevierStyleInf">123</span>&#41; 43&#46;98&#37;&#44; &#40;P<span class="elsevierStyleInf">234</span>&#41; 51&#46;2&#37;&#44; &#40;P<span class="elsevierStyleInf">345</span>&#41; 53&#46;01&#37; and &#40;P<span class="elsevierStyleInf">456</span>&#41; 55&#46;22&#37;&#46; Control was observed in 200 patients using the first office BP reading &#40;P<span class="elsevierStyleInf">1</span>&#41;&#44; 187 of them had also controlled the successive second reading &#40;P<span class="elsevierStyleInf">1</span> and P<span class="elsevierStyleInf">2</span>&#41;&#44; 93&#46;5 &#91;90&#46;1&#8211;96&#46;9&#93; &#37;&#44; and 181 subjects had good control of first&#44; second and third successive readings &#40;P<span class="elsevierStyleInf">1</span> and P<span class="elsevierStyleInf">2</span> and P<span class="elsevierStyleInf">3</span>&#41;&#44; representing a 90&#46;5 &#91;86&#46;4&#8211;94&#46;6&#93;&#37; of those 200 patients&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The prevalence of MUCH on the whole sample according to the various groups of office BP readings is shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the Pearson correlations between 24-h ABPM and the means of the four groups of office BP readings&#46; No significant association between the different definitions of MUCH and LVH &#40;by electrocardiogram&#41; or microalbuminuria was found &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Correct diagnosis of hypertension currently requires the combined evaluation of office and ambulatory BP&#46; This is particularly evident when a diagnosis of white-coat hypertension is made&#46; However&#44; the diagnosis of masked hypertension also requires an accurate assessment of office BP&#46; The varying prevalences of masked hypertension found in different studies are related not only to variations in patient samples evaluated in each study&#44; but also to aspects of the measurement of office BP&#46; For example&#44; the characteristics of BP measured repeatedly in a single clinic visit could be predictive of clinical differences in BP between repeated home and clinic measurements&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a> The interesting study of Banegas et al<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">10</span></a> included a high number of subjects&#46; They performed only two office BP measurements and they found a MUCH prevalence of 31&#37;&#46; Considering the results of our study&#44; it could be assumed that&#44; if more BP readings had been made&#44; the prevalence of MUCH would have been even greater&#46; Nevertheless&#44; the differences between the prevalence of MUCH found by Banegas et al&#46; and the prevalence in our study could be explained by differences between the two samples&#46; Our sample is recruited just from a specialized hospital setting&#44; with higher prevalence of associated cardiovascular disease and probably with longer duration of hypertension&#44; more frequent evaluations of ambulatory blood pressure&#44; and more number and higher doses of antihypertensive drugs&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Our results show that the method of measuring office BP influences the diagnosis of MUCH&#46; Office BP was measured under optimal conditions by doctors and nurses from various specialized Spanish hypertension units&#46; However&#44; office BP decreased gradually in successive BP readings&#44; even after initial rest and in the context of the baseline conditions of an experimental study&#46; There was a reduction of up to 7<span class="elsevierStyleHsp" style=""></span>mmHg for systolic BP and up to 3&#46;6<span class="elsevierStyleHsp" style=""></span>mmHg for diastolic between the first and sixth readings&#46; Therefore&#44; the prevalence of MUCH ranged between 14&#46;5&#37; in the first reading to 21&#46;1&#37; in the sixth reading in our study&#46; Pearson correlations between ambulatory BP and each of the four groups of means office BP were quite similar&#46; However&#44; the best correlation was with diastolic 24-h ABPM and the mean diastolic office BP of the last three readings&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Thus&#44; it seems that the inclusion or not of the first office BP readings is crucial in defining MUCH&#44; especially the first reading&#46; Most patients in our study had an alert reaction after the first office BP reading&#44; despite the prior rest period&#46; This alert reaction lessened progressively in successive readings&#46; These reactions were similar when office BP was measured by physicians or nurses&#46; However&#44; the results might have differed if readings had been made using automatic BP monitors&#44; without any medical intervention&#46; That makes office BP values closer to the mean daytime BP &#40;ABPM or HBPM&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a> However&#44; it appears that the first BP readings are also higher in this case&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">18</span></a> For example&#44; Myers et al&#46; found a BP reduction between the first and sixth automatic office measurements&#58; 14<span class="elsevierStyleHsp" style=""></span>mmHg for systolic BP and 5<span class="elsevierStyleHsp" style=""></span>mmHg for diastolic BP&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> And in our experience&#44; an alert reaction is even detected in the first self-measurement by the patient&#44; with an increase of systolic BP&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">None of the four groups of BP readings was significantly associated with subclinical organ damage&#44; particularly with urinary albumin excretion or electrocardiographic criteria for left ventricular hypertrophy&#46; It may be that a larger sample size would be needed to detect an association of this type&#44; and this is a limitation of the study&#46; Another potential limitation is the variability of BP measurement given the many investigators and participating centers&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">It is known that the masked phenomena are higher in treated hypertensive patients than in untreated&#46; This could be because there are other uncontrolled BP measurement and treatment aspects that could influence the office BP variability and therefore may affect the prevalence of MUCH&#58; the time of office BP measurement&#44; the time of taking the antihypertensive medication&#44; the effect of postprandial hypotension in the elderly&#44; the antihypertensive treatment nighttime noncompliance when ABPM is performed or unrecognized consumption of other drugs or alcohol&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a> However&#44; we suggest that this variability reflects usual clinical practice and that our results are robust&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0090" class="elsevierStylePara elsevierViewall">In conclusion&#44; our results suggest that the first two office BP readings should routinely be discarded and a mean value should be taken from subsequent readings&#44; except for patients whose first reading is &#60;140&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg&#44; because successive readings were even lower in 90&#37; of cases&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">There are no conflicts of interest&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The reported prevalence of masked uncontrolled hypertension &#40;MUCH&#41; varies because many studies are not comparable as they use different measurement methodologies&#46; To evaluate the influence of the number of office blood pressure readings on the prevalence of MUCH we conducted a cross-sectional&#44; multicenter study in treated hypertensive patients&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We carried out an observational&#44; cross-sectional&#44; multicenter study in 33 Spanish hospital-based hypertension units&#44; involving 35 investigators and 12 Autonomous Communities&#46; Six blood pressure readings and a 24-h ambulatory blood pressure monitoring were performed in treated hypertensive patients&#46; The means of the first 3 readings &#40;P<span class="elsevierStyleInf">123</span>&#41;&#44; the 2nd&#44; 3rd and 4th readings &#40;P<span class="elsevierStyleInf">234</span>&#41;&#44; the 3rd&#44; 4th and 5th readings &#40;P<span class="elsevierStyleInf">345</span>&#41; and the last 3 readings &#40;P<span class="elsevierStyleInf">456</span>&#41; were compared with mean 24-h blood pressure&#46; MUCH was defined as office blood pressure &#60;140&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg and 24-h blood pressure &#8805;130&#47;80<span class="elsevierStyleHsp" style=""></span>mmHg&#44; considering the first 3 readings &#40;MUCH<span class="elsevierStyleInf">123</span>&#41;&#44; the 2nd&#44; 3rd and 4th readings &#40;MUCH<span class="elsevierStyleInf">234</span>&#41;&#44; the 3rd&#44; 4th and 5th readings &#40;MUCH<span class="elsevierStyleInf">345</span>&#41; and the last 3 readings &#40;MUCH<span class="elsevierStyleInf">456</span>&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We included 498 hypertensive patients&#46; Mean &#40;standard deviation&#41; office blood pressure measurements were&#58; &#40;P<span class="elsevierStyleInf">123</span>&#41; 141&#40;18&#41;&#47;82&#40;11&#41;&#59; &#40;P<span class="elsevierStyleInf">234</span>&#41; 139&#40;17&#41;&#47;81&#40;11&#41;&#59; &#40;P<span class="elsevierStyleInf">345</span>&#41; 138&#40;17&#41;&#47;81&#40;11&#41; and &#40;P<span class="elsevierStyleInf">456</span>&#41; 137&#40;16&#41;&#47;80&#40;10&#41; mmHg&#46; Mean 24-h blood pressure was 127&#40;13&#46;8&#41;&#47;75&#40;9&#46;5&#41; mmHg&#46; The correlation coefficients between ambulatory and office systolic&#47;diastolic blood pressure were &#40;P<span class="elsevierStyleInf">123</span>&#41;&#58;0&#46;48&#47;0&#46;50&#59; &#40;P<span class="elsevierStyleInf">234</span>&#41;&#58;0&#46;50&#47;0&#46;52&#59; &#40;P<span class="elsevierStyleInf">345</span>&#41;&#58;0&#46;50&#47;0&#46;54&#59; and &#40;P<span class="elsevierStyleInf">456</span>&#41;&#58;0&#46;50&#47;0&#46;55 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#44; all&#41;&#46; The prevalences of MUCH<span class="elsevierStyleInf">123</span>&#44; MUCH<span class="elsevierStyleInf">234</span>&#44; MUCH<span class="elsevierStyleInf">345</span> and MUCH<span class="elsevierStyleInf">456</span> were 14&#46;5&#37;&#44; 18&#46;9&#37;&#44; 19&#46;5&#37; and 21&#46;1&#37;&#44; respectively&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The prevalence of MUCH diagnosis depends on the serial office blood pressure readings&#44; being much higher for the last three blood pressure readings&#46; Discarding the first and second office blood pressure measures seems to be the most accurate method for diagnosing MUCH&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction and objectives"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Patients and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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        ]
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n y objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los datos sobre prevalencia de hipertensi&#243;n arterial enmascarada no controlada &#40;HTAE&#41; son muy variables&#44; ya que los registros obtenidos en diferentes estudios no son comparables al emplear diferentes m&#233;todos de medici&#243;n&#46; Se llev&#243; a cabo un estudio transversal y multic&#233;ntrico en pacientes hipertensos tratados para evaluar la influencia de la cantidad de lecturas de la presi&#243;n arterial en consulta sobre la prevalencia de la HTAE&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio observacional&#44; transversal y multic&#233;ntrico en 33 unidades de hipertensi&#243;n en hospitales espa&#241;oles&#44; con la participaci&#243;n de 35 investigadores y 12 comunidades aut&#243;nomas&#46; Se realizaron 6 lecturas de la presi&#243;n arterial y un control de la presi&#243;n arterial ambulatoria de 24<span class="elsevierStyleHsp" style=""></span>h en pacientes hipertensos tratados&#46; Se compararon las medias de las 3 primeras lecturas &#40;P<span class="elsevierStyleInf">123</span>&#41;&#44; de las lecturas 2&#44; 3 y 4 &#40;P<span class="elsevierStyleInf">234</span>&#41;&#44; de las lecturas 3&#44; 4 y 5 &#40;P<span class="elsevierStyleInf">345</span>&#41; y de las 3 &#250;ltimas lecturas &#40;P<span class="elsevierStyleInf">456</span>&#41; con la media de la presi&#243;n arterial a las 24<span class="elsevierStyleHsp" style=""></span>h&#46; Teniendo en cuenta las 3 primeras lecturas &#40;HTAE<span class="elsevierStyleInf">123</span>&#41;&#44; las lecturas segunda&#44; tercera y cuarta &#40;HTAE<span class="elsevierStyleInf">234</span>&#41;&#44; tercera&#44; cuarta y quinta &#40;HTAE<span class="elsevierStyleInf">345</span>&#41; y las &#250;ltimas 3 lecturas &#40;HTAE<span class="elsevierStyleInf">456</span>&#41;&#59; definimos la HTAE como una presi&#243;n arterial en consulta &#60;140&#47;90<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg y una presi&#243;n arterial de 24<span class="elsevierStyleHsp" style=""></span>h &#8805;<span class="elsevierStyleHsp" style=""></span>130&#47;80<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 498 pacientes hipertensos&#46; La media de las mediciones &#40;desviaci&#243;n est&#225;ndar&#41; de presi&#243;n arterial en consulta fueron&#58; &#40;P<span class="elsevierStyleInf">123</span>&#41; 141 &#40;18&#41;&#47;82 &#40;11&#41;&#59; &#40;P<span class="elsevierStyleInf">234</span>&#41; 139 &#40;17&#41;&#47;81 &#40;11&#41;&#59; &#40;P<span class="elsevierStyleInf">345</span>&#41; 138 &#40;17&#41;&#47;81 &#40;11&#41; y &#40;P<span class="elsevierStyleInf">456</span>&#41; 137 &#40;16&#41;&#47;80 &#40;10&#41; mm<span class="elsevierStyleHsp" style=""></span>Hg&#46; La presi&#243;n arterial media a las 24<span class="elsevierStyleHsp" style=""></span>h fue de 127 &#40;13&#46;8&#41;&#47;75 &#40;9&#46;5&#41; mm<span class="elsevierStyleHsp" style=""></span>Hg&#46; Los coeficientes de correlaci&#243;n entre presi&#243;n sist&#243;lica&#47;presi&#243;n diast&#243;lica ambulatoria y en consulta fueron &#40;P<span class="elsevierStyleInf">123</span>&#41;&#58; 0&#46;48&#47;0&#46;50&#59; &#40;P<span class="elsevierStyleInf">234</span>&#41;&#58; 0&#46;50&#47;0&#46;52&#59; &#40;P<span class="elsevierStyleInf">345</span>&#41;&#58; 0&#46;50&#47;0&#46;54&#59; y &#40;P<span class="elsevierStyleInf">456</span>&#41;&#58; 0&#46;50&#47;0&#46;55 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001 de todos&#41;&#46; Las prevalencias de HTAE<span class="elsevierStyleInf">123</span>&#44; HTAE<span class="elsevierStyleInf">234</span>&#44; HTAE<span class="elsevierStyleInf">345</span> y HTAE<span class="elsevierStyleInf">456</span> fueron 14&#46;5&#37;&#44; 18&#46;9&#37;&#44; 19&#46;5&#37; y 21&#46;1&#37;&#44; respectivamente&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de diagn&#243;stico de HTAE depende de las series de lecturas de la presi&#243;n arterial en consulta&#44; siendo esta mucho m&#225;s alta en las 3 &#250;ltimas lecturas&#46; Si descartamos la primera y segunda lecturas&#44; la medida de la presi&#243;n arterial en consulta parece ser el m&#233;todo m&#225;s preciso para el diagn&#243;stico de la HTAE&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Introducci&#243;n y objetivos"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Pacientes y m&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Mean &#40;standard deviation&#41; of the 6 office blood pressure readings&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Prevalences &#91;95&#37; CI&#93; of masked uncontrolled hypertension &#40;MUCH&#41; considering the four definitions based in successive office blood pressure readings&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">SD&#58; standard deviation&#59; BMI&#58; body mass index&#59; BP&#58; blood pressure</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Women&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">206 &#40;41&#46;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Age&#44; years&#59; <span class="elsevierStyleItalic">mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60 &#40;13&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Family history of premature cardiovascular disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78 &#40;15&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">BMI &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&#59; <span class="elsevierStyleItalic">mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#46;1 &#40;4&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Waist circumference &#40;cm&#41;&#59; <span class="elsevierStyleItalic">mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99&#46;1 &#40;12&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Smoking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61 &#40;12&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Alcohol consumption<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>30<span class="elsevierStyleHsp" style=""></span>g&#47;day&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;2&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Type 2 diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130 &#40;26&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Hypercholesterolemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">320 &#40;64&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Electrocardiographic left ventricular hypertrophy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;4&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Chronic kidney disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;18&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Associated cardiovascular disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">146 &#40;29&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Office BP &#40;mmHg&#41;&#59; mean of all readings &#40;SD&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Systolic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">139 &#40;16&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Diastolic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81 &#40;10&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">24-h BP &#40;mmHg&#41;&#59; mean &#40;SD&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Systolic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">127 &#40;13&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Diastolic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75 &#40;9&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Daytime BP &#40;mmHg&#41;&#59; mean &#40;SD&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Systolic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">131 &#40;14&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Diastolic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78 &#40;10&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Night-time BP &#40;mmHg&#41;&#59; mean &#40;SD&#41;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Systolic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">120 &#40;15&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Diastolic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69 &#40;9&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Office heart rate &#40;<span class="elsevierStyleItalic">beats per minute&#41;&#59; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74 &#40;11&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Night-time HR <span class="elsevierStyleItalic">&#40;beats per minute&#41;&#59; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67 &#40;9&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Sociodemographic and clinical characteristics of subjects&#46; Values are numbers &#40;percentage&#41; unless otherwise indicated &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>498&#41;&#46;</p>"
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">OBP<span class="elsevierStyleInf">123</span>&#58; definition based in the mean of the 1st&#44; 2nd and 3rd office blood pressure readings&#59; OBP<span class="elsevierStyleInf">234</span>&#58; idem of 2nd&#44; 3rd and 4th readings&#59; OBP<span class="elsevierStyleInf">345</span>&#58; idem of 3rd&#44; 4th and 5th readings&#59; OBP<span class="elsevierStyleInf">456</span>&#58; idem of 4th&#44; 5th and 6th readings&#46;</p>"
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        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0100" class="elsevierStylePara elsevierViewall">This study was possible thanks to the collaboration of the ESTHEN Investigators&#58; Celia Fernandez Torres&#44; Fernando Gamazo Chill&#243;n&#44; Maria Luisa M&#233;ndez P&#233;rez&#44; Saturnino Su&#225;rez Ortega&#44; Mario Baquero Alonso&#44; Carlos Escobar Cervantes&#44; Juan Bautista Montagud Moncho&#44; Gema Fern&#225;ndez Fresnedo&#44; Antonio Vicente Casanova&#44; Juan Diego Mediavilla Garcia&#44; Francisco Fernandez Montero&#44; Joaqu&#237;n Rueda Soriano&#44; Francisco Javier Guerrero Camacho&#44; Joaqu&#237;n Vila Planas&#44; Javier Sobrino Martinez&#44; Maria Jesus Adrian Martin&#44; Blanca Batalla Insenser&#44; M&#243;nica Domenech Feria-Carot&#44; Manuel Rayo Guti&#233;rrez&#44; Juan Manuel Maraver Delgado&#44; Alfonso Segarra Medrano&#44; Juan Carlos Rodriguez Garcia&#44; Jos&#233; Luis Griera Borr&#225;s&#44; Antoni Riera Mestre&#44; Guillermo Oller Martinez&#44; M&#170; Angela Felip Benach&#44; &#193;lvaro Hermida Ameijeiras&#44; Jose Saban Ruiz&#44; Jordi Calls Ginesta&#44; Juan Ram&#243;n G&#243;mez-Martino Arroyo&#44; Jose Enrique Castillo Lue&#241;a Luis Miguel Cuadrado G&#243;mez&#44; Miguel Camafort Babkowski&#44; Ferr&#225;n Trias Vilagut&#44; Melit&#243;n Francisco D&#225;vila Ramos&#44; Francisco Jos&#233; Fuentes Jim&#233;nez&#44; Rafael Emilio &#193;lvarez Navascues&#44; Jos&#233; Emilio S&#225;nchez &#193;lvarez&#44; Eva Mar&#237;a Rodr&#237;guez G&#243;mez&#44; whom the authors thank for their interest and dedication&#46; The authors thank Albert Cobos and Salvador Bergo&#241;on from SAALIG&#44; for their important contribution to the statistical analysis&#46;</p> <p id="par0105" class="elsevierStylePara elsevierViewall">The logistic elements of the study were funded by Menarini&#44; S&#46;A&#46; &#40;Spain&#41;&#46;</p>"
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Información del artículo

ISSN: 00142565
Idioma original: Inglés

DOI:10.1016/j.rce.2015.06.007

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