Similar levels of low-grade inflammation and arterial stiffness in masked and white-coat hypertension: comparisons with sustained hypertension and normotension

Objective The clinical significance of masked hypertension (MHT) and white-coat hypertension (WCHT) remains controversial, whereas subclinical inflammation and arterial stiffness are associated with an adverse prognosis. We examined the interrelationships of MHT, WCHT, and sustained hypertension (SHT) with high-sensitivity C-reactive protein (hs-CRP) and arterial stiffness. Methods Our population consisted of 291 untreated nondiabetic patients with MHT [ office blood pressure (BP) < 140/90mmHg and daytime BP >= 135/85mmHg; n= 32], WCHT (office BP >= 140/90mmHg and daytime BP < 135/85mmHg; n= 81), SHT (office BP >= 140/90mmHg and daytime BP >= 135/85mmHg; n= 178), and 44 age-matched and sex-matched control normotensives. Results SHT compared with WCHT, MHT, and normotension exhibited higher pulse wave velocity (PWV; 8.2 +/- 1.4 vs. 7.5 +/- 1.2 vs. 7.3 +/- 0.9 vs. 6.8 +/- 0.5 m/s, respectively; P < 0.05) and hs-CRP (2.8 +/- 0.7 vs. 2.2 +/- 0.6 vs. 1.9 +/- 0.4 vs. 1.2 +/- 0.3 mg/l, respectively; P < 0.05), independently of confounders. Of note, there was no difference between the MHT and WCHT groups with regard to hs-CRP and PWV levels (P= not significant). In hypertensives, hs-CRP was associated with 24-h systolic BP (r= 0.350, P < 0.0001) and PWV (r= 0.228, P < 0.0001), whereas PWV was associated with 24-h systolic BP (r = 0.330, P < 0.0001). Conclusion MHT and WCHT represent two states of equivalent subclinical vascular dysfunction reflected by hs-CRP and PWV. Moreover, MHT and WCHT are characterized by a higher degree of inflammatory activation and arterial stiffening compared with normotension and by a lesser degree compared with SHT. The association of 24-h BP with both hs-CRP and PWV underscores the dominant role of hemodynamic load on hypertensive damage progression. Blood Press Monit 16: 218-223 (C) 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.