Smoking and overweight associated with masked uncontrolled hypertension: a Hypertension Optimal Treatment (HOT) Sub-Study

Abstract

Purpose

The Hypertension Optimal Treatment (HOT) Study investigated the relationship between target office diastolic blood pressure (BP) ≤80, ≤85 or ≤90 mmHg and cardiovascular morbidity and mortality in 18,790 patients aged 50–80 years. The home BP sub-study enrolled 926 patients and the aim was to clarify whether the separation into the BP target groups in the office prevailed in the out-of-office setting. The present study aimed to identify variables that characterised masked uncontrolled hypertension (MUCH) and white coat uncontrolled hypertension (WUCH).

Material and Methods

The sub-study participants took their home BP when office BP had been up titrated. The cut-off for normal or high BP was set to ≥135/85 mmHg at home and ≥140/90 mmHg in the office. We analysed data by using multivariate and stepwise multivariate logistic regression with home and office BP combinations as the dependent variables.

Results

WUCH was associated with lower body mass index (BMI) (odds ratio (OR) 0.92, 95% confident intervals (CIs) 0.88–0.96, p < 0.001). MUCH was associated with smoking (OR 1.89, 95% CIs 1.25–2.86, p = 0.0025) and with lower baseline heart rate (OR 0.98, 95% CIs 0.97–0.99, p = 0.03) and higher BMI (OR 1.03, CIs 1.00–1.06, p = 0.04). MUCH remained associated with smoking (OR 2.76, 95% CIs 1.76–4.35, p < 0.0001) also when using ≥140/90 mmHg as the cut-off for both home and office BP. MUCH was also associated with higher BMI (OR 1.05, 95% CIs 1.01–1.09, p = 0.009) while WUCH was associated with lower BMI (OR 0.93, 95% CIs 0.90–0.97, p = 0.0005) when using ≥140/90 mmHg as a cut-off.

Conclusion

Our data support that ‘reversed or masked’ treated but uncontrolled hypertension (MUCH) is common and constitutes about 25% of treated hypertensive patients. This entity (MUCH) is rather strongly associated with current smoking and overweight while uncontrolled white coat (office) hypertension (WUCH) is associated with lower BMI.

Keywords:

• Blood pressure
• hypertension
• masked hypertension
• smoking
• overweight

Acknowledgements

This study received support from Astra, Mölndal, Sweden. The authors are thankful to Nils-Gunnar Pehrsson at the HOT Coordinating Center at Sahlgrenska Hospital Östra, now at Statistiska Konsultgruppen, Gothenburg, Sweden, for data processing and statistical work.

Disclosure statement

No potential conflict of interest was reported by the authors.