Relationship between joint national committee‐VI classification of hypertension and ambulatory blood pressure in patients with hypertension diagnosed by casual blood pressure

• Published in: Clinical cardiology (Mahwah, N.J.) Vol. 21; no. 11; pp. 801 - 806
• Main Authors: Inden, Yasuya, Tsuda, Makoto, Mayashi, Hiroshi, Takezawa, Hiroto, Iino, Shigeo, Kondo, Takahisa, Yoshida, Yukihiko, Akahoshi, Makoto, Terasawa, Masayuki, Itoh, Teruo, Saito, Hdehiko, Hirai, Makoto
• Format: Journal Article
• Language: English
• Published: New York Wiley Periodicals, Inc 01.11.1998; Wiley
• Subjects: Adult; Aged; Aged, 80 and over; ambulatory blood pressure; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure Determination; Blood Pressure Monitoring, Ambulatory; Cardiology. Vascular system; Clinical Investigation; Clinical Investigations; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Diagnosis, Differential; Female; Humans; hypertension; Hypertension - classification; Hypertension - diagnosis; Hypertension - physiopathology; JNCVI classification; Male; Medical sciences; Middle Aged; white‐coat hypertension; Human; Hypertension; Prevalence; Cardiovascular disease; Exploration; Borderline hypertension; Differential diagnostic; Classification; Severity score; Blood pressure; Ambulatory; Diagnosis; Measurement method; Comparative study; Monitoring
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.4960211104

Background: White‐coat hypertension has been diagnosed arbitrarily based on different criteria. In 1997, the Joint National Committee‐VI (JNC‐VI) reported a new classification of hypertension and strongly emphasized the importance of ambulatory blood pressure (ABP) monitoring. The report pronounced normal ABP values for the first time. Hypothesis: The study's aim was to clarify the relationship between casual blood pressure (BP) and ABP of patients with essential hypertension in each stage of JNC‐VI classification, and the prevalence of white‐coat hypertension diagnosed by using JNC‐VI normal ABP criteria. Methods: Ambulatory blood pressure was monitored noninvasively in 232 patients with essential hypertension whose casual BP was ≥ 140/90 mmHg. The patients were classified according to JNC‐VI classification, and their casual BP was compared with ABP. The criterion of white‐coat hypertension was defined as casual BP ≥ 140/90 mmHg with normal ABP according to JNC‐VI criteria (< 135/85 during daytime and < 120/75 during nighttime). Results: Mean ABP increased as the stage advanced, and the differences between casual BP and ABP also increased. There were considerable overlaps in the distribution of ABP among stages. The prevalence of white‐coat hypertension was 13% overall: 30% of the patients with isolated systolic hypertension, 19% of those in stage 1,10% in stage 2, and 4% in stage 3. Conclusions: Classification of hypertension based on casual BP may not always correspond in severity to that based on ABP. Ambulatory blood pressure monitoring recommended by JNC‐VI is very useful for the evaluation of hypertension to differentiate white‐coat hypertension from true hypertension.