Chronic hypertension differential diagnosis: Difference between revisions

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===White Coat Hypertension===
===White Coat Hypertension===
White coat hypertension, more commonly known as '''white coat syndrome''', is a phenomenon in which patients exhibit elevated [[blood pressure]] in a clinical setting but not in other settings.<ref name="pmid24107724">{{cite journal| author=Mancia G, Fagard R, Narkiewicz K, Redán J, Zanchetti A, Böhm M et al.| title=2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. | journal=J Hypertens | year= 2013 | volume= 31 | issue= 10 | pages= 1925-38 | pmid=24107724 | doi=10.1097/HJH.0b013e328364ca4c | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24107724 }} </ref> The prevalence of white coat hypertension is approximately 13%.<ref name="pmid17921809">{{cite journal| author=Fagard RH, Cornelissen VA| title=Incidence of cardiovascular events in white-coat, masked and sustained hypertension versus true normotension: a meta-analysis. | journal=J Hypertens | year= 2007 | volume= 25 | issue= 11 | pages= 2193-8 | pmid=17921809 | doi=10.1097/HJH.0b013e3282ef6185 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17921809 }} </ref> Risk factors for white coat hypertension in observational studies include age, female sex, and being a non-smoker.  The higher the blood pressure in the clinical setting, the lower the probability of white coat hypertension.<ref name="pmid24107724">{{cite journal| author=Mancia G, Fagard R, Narkiewicz K, Redán J, Zanchetti A, Böhm M et al.| title=2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. | journal=J Hypertens | year= 2013 | volume= 31 | issue= 10 | pages= 1925-38 | pmid=24107724 | doi=10.1097/HJH.0b013e328364ca4c | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24107724 }} </ref> Ambulatory blood pressure monitoring and patient self-measurement using a home blood pressure monitoring device are being increasingly used to differentiate patients with white coat hypertension from patients with true hypertension. Ambulatory monitoring has been found to be a more practical and reliable method in detecting patients with white coat hypertension and for the prediction of target organ damage. Even as such, the diagnosis and treatment of white coat hypertension remains controversial.<ref name="pmid16647616">{{cite journal |author=Niiranen TJ, Kantola IM, Vesalainen R, Johansson J, Ruuska MJ |title=A comparison of home measurement and ambulatory monitoring of blood pressure in the adjustment of antihypertensive treatment |journal=Am. J. Hypertens. |volume=19|issue=5 |pages=468–74 |year=2006 |month=May |pmid=16647616 |doi=10.1016/j.amjhyper.2005.10.017}}</ref> According to ESC/ESH recommendations in 2013, white coat hypertension must be confirmed within 3-6 months of diagnosis and close follow-up, evaluation, and periodical out-of-office BP measurements are also required.<ref name="pmid24107724">{{cite journal| author=Mancia G, Fagard R, Narkiewicz K, Redán J, Zanchetti A, Böhm M et al.| title=2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. | journal=J Hypertens | year= 2013 | volume= 31 | issue= 10 | pages= 1925-38 | pmid=24107724 | doi=10.1097/HJH.0b013e328364ca4c | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24107724 }} </ref> Finally, target organ damage and prognosis of patients with white coat hypertension is still unknown. Although it was considered an intermediate between normal blood pressure and hypertension(105), larger meta-analyses failed to show any significant difference between patients with white coat hypertension and those with normal blood pressure levels.<ref name="pmid17921809">{{cite journal| author=Fagard RH, Cornelissen VA| title=Incidence of cardiovascular events in white-coat, masked and sustained hypertension versus true normotension: a meta-analysis. | journal=J Hypertens | year= 2007 | volume= 25 | issue= 11 | pages= 2193-8 | pmid=17921809 | doi=10.1097/HJH.0b013e3282ef6185 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17921809 }} </ref><ref name="pmid20847724">{{cite journal| author=Pierdomenico SD, Cuccurullo F| title=Prognostic value of white-coat and masked hypertension diagnosed by ambulatory monitoring in initially untreated subjects: an updated meta analysis. | journal=Am J Hypertens | year= 2011 | volume= 24 | issue= 1 | pages= 52-8 | pmid=20847724 | doi=10.1038/ajh.2010.203 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20847724 }} </ref><ref name="pmid22252396">{{cite journal| author=Franklin SS, Thijs L, Hansen TW, Li Y, Boggia J, Kikuya M et al.| title=Significance of white-coat hypertension in older persons with isolated systolic hypertension: a meta-analysis using the International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes population. | journal=Hypertension | year= 2012 | volume= 59 | issue= 3 | pages= 564-71 | pmid=22252396 | doi=10.1161/HYPERTENSIONAHA.111.180653 | pmc=PMC3607330 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22252396 }} </ref>
White coat hypertension, more commonly known as '''white coat syndrome''', is a phenomenon in which patients exhibit elevated [[blood pressure]] in a clinical setting but not in other settings.<ref name="pmid24107724">{{cite journal| author=Mancia G, Fagard R, Narkiewicz K, Redán J, Zanchetti A, Böhm M et al.| title=2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. | journal=J Hypertens | year= 2013 | volume= 31 | issue= 10 | pages= 1925-38 | pmid=24107724 | doi=10.1097/HJH.0b013e328364ca4c | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24107724 }} </ref> The prevalence of white coat hypertension is approximately 13%.<ref name="pmid17921809">{{cite journal| author=Fagard RH, Cornelissen VA| title=Incidence of cardiovascular events in white-coat, masked and sustained hypertension versus true normotension: a meta-analysis. | journal=J Hypertens | year= 2007 | volume= 25 | issue= 11 | pages= 2193-8 | pmid=17921809 | doi=10.1097/HJH.0b013e3282ef6185 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17921809 }} </ref> Risk factors for white coat hypertension in observational studies include age, female sex, and being a non-smoker.  The higher the blood pressure in the clinical setting, the lower the probability of white coat hypertension.<ref name="pmid24107724">{{cite journal| author=Mancia G, Fagard R, Narkiewicz K, Redán J, Zanchetti A, Böhm M et al.| title=2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. | journal=J Hypertens | year= 2013 | volume= 31 | issue= 10 | pages= 1925-38 | pmid=24107724 | doi=10.1097/HJH.0b013e328364ca4c | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24107724 }} </ref> Ambulatory blood pressure monitoring and patient self-measurement using a home blood pressure monitoring device are being increasingly used to differentiate patients with white coat hypertension from patients with true hypertension. Ambulatory monitoring has been found to be a more practical and reliable method in detecting patients with white coat hypertension and for the prediction of target organ damage. The treatment of white coat hypertension remains controversial.<ref name="pmid16647616">{{cite journal |author=Niiranen TJ, Kantola IM, Vesalainen R, Johansson J, Ruuska MJ |title=A comparison of home measurement and ambulatory monitoring of blood pressure in the adjustment of antihypertensive treatment |journal=Am. J. Hypertens. |volume=19|issue=5 |pages=468–74 |year=2006 |month=May |pmid=16647616 |doi=10.1016/j.amjhyper.2005.10.017}}</ref> The 2013 ESC/ESH recommendations recommend that white coat hypertension be confirmed within 3-6 months of initial diagnosis and that close follow-up and periodic out-of-office BP measurements be obtained.<ref name="pmid24107724">{{cite journal| author=Mancia G, Fagard R, Narkiewicz K, Redán J, Zanchetti A, Böhm M et al.| title=2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. | journal=J Hypertens | year= 2013 | volume= 31 | issue= 10 | pages= 1925-38 | pmid=24107724 | doi=10.1097/HJH.0b013e328364ca4c | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24107724 }} </ref> Finally, target organ damage and prognosis of patients with white coat hypertension is still unknown. Although it was considered an intermediate between normal blood pressure and hypertension(105), larger meta-analyses failed to show any significant difference between patients with white coat hypertension and those with normal blood pressure levels.<ref name="pmid17921809">{{cite journal| author=Fagard RH, Cornelissen VA| title=Incidence of cardiovascular events in white-coat, masked and sustained hypertension versus true normotension: a meta-analysis. | journal=J Hypertens | year= 2007 | volume= 25 | issue= 11 | pages= 2193-8 | pmid=17921809 | doi=10.1097/HJH.0b013e3282ef6185 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17921809 }} </ref><ref name="pmid20847724">{{cite journal| author=Pierdomenico SD, Cuccurullo F| title=Prognostic value of white-coat and masked hypertension diagnosed by ambulatory monitoring in initially untreated subjects: an updated meta analysis. | journal=Am J Hypertens | year= 2011 | volume= 24 | issue= 1 | pages= 52-8 | pmid=20847724 | doi=10.1038/ajh.2010.203 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20847724 }} </ref><ref name="pmid22252396">{{cite journal| author=Franklin SS, Thijs L, Hansen TW, Li Y, Boggia J, Kikuya M et al.| title=Significance of white-coat hypertension in older persons with isolated systolic hypertension: a meta-analysis using the International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes population. | journal=Hypertension | year= 2012 | volume= 59 | issue= 3 | pages= 564-71 | pmid=22252396 | doi=10.1161/HYPERTENSIONAHA.111.180653 | pmc=PMC3607330 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22252396 }} </ref>


===Masked Hypertension===
===Masked Hypertension===

Revision as of 20:33, 10 May 2014

Hypertension Main page

Overview

Causes

Classification

Primary Hypertension
Secondary Hypertension
Hypertensive Emergency
Hypertensive Urgency

Screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-In-Chief: Yazan Daaboul, Serge Korjian, Taylor Palmieri

Overview

Before the diagnosis of primary (essential) hypertension, secondary causes of hypertension should be ruled out. Additionally, other conditions that may elevate BP include: White coat hypertension, masked hypertension, and pseudohypertension.

Differerentiating Hypertension from other Diseases

Before the diagnosis of primary (essential) hypertension is made, other causes of hypertension should be considered.

Secondary Hypertension

Although it is not practical to rule out secondary hypertension in every hypertensive patient, secondary hypertension should be considered if there is early onset of hypertension before the age of 30, if there is the abrupt onset of hypertension, if there rapid progression of hypertension, and if there is a hypertensive urgency or hypertensive emergency.

White Coat Hypertension

White coat hypertension, more commonly known as white coat syndrome, is a phenomenon in which patients exhibit elevated blood pressure in a clinical setting but not in other settings.[1] The prevalence of white coat hypertension is approximately 13%.[2] Risk factors for white coat hypertension in observational studies include age, female sex, and being a non-smoker. The higher the blood pressure in the clinical setting, the lower the probability of white coat hypertension.[1] Ambulatory blood pressure monitoring and patient self-measurement using a home blood pressure monitoring device are being increasingly used to differentiate patients with white coat hypertension from patients with true hypertension. Ambulatory monitoring has been found to be a more practical and reliable method in detecting patients with white coat hypertension and for the prediction of target organ damage. The treatment of white coat hypertension remains controversial.[3] The 2013 ESC/ESH recommendations recommend that white coat hypertension be confirmed within 3-6 months of initial diagnosis and that close follow-up and periodic out-of-office BP measurements be obtained.[1] Finally, target organ damage and prognosis of patients with white coat hypertension is still unknown. Although it was considered an intermediate between normal blood pressure and hypertension(105), larger meta-analyses failed to show any significant difference between patients with white coat hypertension and those with normal blood pressure levels.[2][4][5]

Masked Hypertension

The term "masked hypertension" can be used to describe a contrasting phenomenon from that of white coat hypertension, where blood pressure is elevated during daily living, but not in an office setting.[6] Similarly, the prevalence of masked hypertension is also thought to be approximately 13% and tends to increase when office BP values are high-normal.[7][8] Risk factors for masked hypertension include young age, male gender, smoking, alcohol, physical exercise, anxiety and stress, obesity, diabetes, chronic renal insufficiency, and family history of hypertension. In contrast to white coat hypertension, patients with masked hypertension are at a two-fold increased risk of cardiovascular events and target organ damage, especially when BP levels are elevated at night.[9][10]

Pseudohypertension

Pseudohypertension is defined as marked arterial stiffness associated with calcification of brachial arteries that require much higher cuff-inflating pressures to occlude. Measurements of blood pressure values in the clinic might thus be falsely high.[1] Pseudohypertension is more common among elderly patients.[1]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Mancia G, Fagard R, Narkiewicz K, Redán J, Zanchetti A, Böhm M; et al. (2013). "2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension". J Hypertens. 31 (10): 1925–38. doi:10.1097/HJH.0b013e328364ca4c. PMID 24107724.
  2. ↑ 2.0 2.1 Fagard RH, Cornelissen VA (2007). "Incidence of cardiovascular events in white-coat, masked and sustained hypertension versus true normotension: a meta-analysis". J Hypertens. 25 (11): 2193–8. doi:10.1097/HJH.0b013e3282ef6185. PMID 17921809.
  3. ↑ Niiranen TJ, Kantola IM, Vesalainen R, Johansson J, Ruuska MJ (2006). "A comparison of home measurement and ambulatory monitoring of blood pressure in the adjustment of antihypertensive treatment". Am. J. Hypertens. 19 (5): 468–74. doi:10.1016/j.amjhyper.2005.10.017. PMID 16647616. Unknown parameter |month= ignored (help)
  4. ↑ Pierdomenico SD, Cuccurullo F (2011). "Prognostic value of white-coat and masked hypertension diagnosed by ambulatory monitoring in initially untreated subjects: an updated meta analysis". Am J Hypertens. 24 (1): 52–8. doi:10.1038/ajh.2010.203. PMID 20847724.
  5. ↑ Franklin SS, Thijs L, Hansen TW, Li Y, Boggia J, Kikuya M; et al. (2012). "Significance of white-coat hypertension in older persons with isolated systolic hypertension: a meta-analysis using the International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes population". Hypertension. 59 (3): 564–71. doi:10.1161/HYPERTENSIONAHA.111.180653. PMC 3607330. PMID 22252396.
  6. ↑ Pickering TG, Eguchi K, Kario K (2007). "Masked hypertension: a review" (– Scholar search). Hypertens. Res. 30 (6): 479–88. doi:10.1291/hypres.30.479. PMID 17664850. Unknown parameter |month= ignored (help)[dead link]
  7. ↑ Parati G, Ulian L, Santucciu C, Omboni S, Mancia G (1998). "Difference between clinic and daytime blood pressure is not a measure of the white coat effect". Hypertension. 31 (5): 1185–9. PMID 9576133.
  8. ↑ Bobrie G, Clerson P, Ménard J, Postel-Vinay N, Chatellier G, Plouin PF (2008). "Masked hypertension: a systematic review". J Hypertens. 26 (9): 1715–25. doi:10.1097/HJH.0b013e3282fbcedf. PMID 18698202.
  9. ↑ Lurbe E, Redon J, Kesani A, Pascual JM, Tacons J, Alvarez V; et al. (2002). "Increase in nocturnal blood pressure and progression to microalbuminuria in type 1 diabetes". N Engl J Med. 347 (11): 797–805. doi:10.1056/NEJMoa013410. PMID 12226150.
  10. ↑ Wijkman M, Länne T, Engvall J, Lindström T, Ostgren CJ, Nystrom FH (2009). "Masked nocturnal hypertension--a novel marker of risk in type 2 diabetes". Diabetologia. 52 (7): 1258–64. doi:10.1007/s00125-009-1369-9. PMID 19396423.

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