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Observational Study
. 2017 Jan;40(1):87-95.
doi: 10.1038/hr.2016.87. Epub 2016 Aug 11.

Increased cardiovascular risk of treated white coat and masked hypertension in patients with diabetes and chronic kidney disease: the HONEST Study

Toshio Kushiro  1 , Kazuomi Kario  2 , Ikuo Saito  3 , Satoshi Teramukai  4 , Yuki Sato  5 , Yasuyuki Okuda  5 , Kazuyuki Shimada  6
Affiliations
Observational Study

Increased cardiovascular risk of treated white coat and masked hypertension in patients with diabetes and chronic kidney disease: the HONEST Study

Toshio Kushiro et al. Hypertens Res. 2017 Jan.

Abstract

The prognostic implications of treated white coat hypertension (WCH) and masked hypertension (MH) in patients with diabetes mellitus (DM) or chronic kidney disease (CKD) are not well documented. Using data from the HONEST study (n=21 591), we investigated the relationships between morning home systolic blood pressure (MHSBP) or clinic systolic blood pressure (CSBP) and cardiovascular (CV) risk in hypertensive patients with and without DM or CKD receiving olmesartan-based antihypertensive therapy. The study included 4426 DM patients and 4346 CKD patients at baseline who had 101 and 87 major CV events, respectively, during the follow-up. Compared with well-controlled non-DM patients (MHSBP <135 mm Hg; CSBP <140 mm Hg), DM patients with WCH (MHSBP <135 mm Hg; CSBP ⩾140 mm Hg), MH (MHSBP ⩾135 mm Hg; CSBP <140 mm Hg) or poorly controlled hypertension (PCH) (MHSBP ⩾135 mm Hg; CSBP ⩾140 mm Hg) had significantly higher CV risk (hazard ratio (HR), 2.73, 2.77 and 2.81, respectively). CV risk was also significantly increased in CKD patients with WCH, MH and PCH (HR, 2.14, 1.70 and 2.20, respectively) compared with well-controlled non-CKD patients. Furthermore, DM patients had significantly higher incidence rate than non-DM patients of MHSBP ⩾125 to <135 mm Hg (HR, 1.98) and ⩾135 to <145 mm Hg (HR, 2.41). In conclusion, both WCH and MH are associated with increased CV risk, and thus control of both MHSBP and CSBP is important to reduce CV risk in DM or CKD patients. The results also suggest that even lower MHSBP (<125 mm Hg) may be beneficial for DM patients, although this conclusion is limited by the small number of patients.

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Conflict of interest statement

Drs TK, KK, IS, ST and KS have received honoraria from Daiichi Sankyo, and Ms YS and Mr YO are employees of Daiichi Sankyo.

Figures

Figure 1
Figure 1
Categories of hypertension status used in the present study. CBP, clinic blood pressure; CH, well-controlled hypertension; MH, masked hypertension; MHBP, morning home blood pressure; PCH, poorly controlled hypertension; WCH, white coat hypertension.
Figure 2
Figure 2
Changes in morning home and clinic blood pressure in patients with and without DM (a, b) and in patients with and without CKD (c, d). *P<0.001 (vs. baseline; Dunnett−Hsu test). CKD, chronic kidney disease; DBP, diastolic blood pressure; DM, diabetes mellitus; SBP, systolic blood pressure.
Figure 3
Figure 3
Relationship between the primary end point and morning home systolic blood pressure (a) or clinic systolic blood pressure (b) in patients with and without diabetes mellitus (DM; reference, <125 mm Hg (a) or <130 mm Hg (b) in non-DM patients; adjusted for sex, age, family history of cardiovascular disease, dyslipidemia, chronic kidney disease (CKD), history of cardiovascular disease and smoking status). Relationship between the primary end point and morning home systolic blood pressure (c) or clinic systolic blood pressure (d) in patients with and without CKD (reference, <125 mm Hg (c) or <130 mm Hg (d) in non-CKD patients; adjusted for sex, age, family history of cardiovascular disease, dyslipidemia, DM, history of cardiovascular disease and smoking status). *P<0.05. BP, blood pressure.
Figure 4
Figure 4
Primary end point in well-controlled hypertension (CH), white coat hypertension (WCH), masked hypertension (MH) and poorly controlled hypertension (PCH) in patients with and without diabetes mellitus (DM) adjusted for sex, age, family history of cardiovascular disease, dyslipidemia, chronic kidney disease (CKD), history of cardiovascular disease and smoking status (*P<0.05 vs. non-DM patients with CH) (a) and in patients with and without CKD adjusted for sex, age, family history of cardiovascular disease, dyslipidemia, DM, history of cardiovascular disease and smoking status (*P<0.05 vs. non-CKD patients with CH) (b). CBP, clinic blood pressure; MHBP, morning home blood pressure.
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