Impact of Clinic Blood Pressure Target on the Prevalence and Predictors of Masked Uncontrolled Hypertension and White-Coat Uncontrolled Hypertension

Background: Identifying masked uncontrolled hypertension (MUCH) and white-coat uncontrolled hypertension (WUCH) without ambulatory blood pressure (ABP) monitoring is challenging. Recent literature advocates intensive blood pressure (BP) control, but standard guidelines still suggest a clinic BP threshold of ≥ 149/90 mmHg to diagnose hypertension. This study explored the impact of different clinic BP targets on the prevalence and predictors of MUCH and WUCH. Methods: This multicenter prospective cohort study included 1,601 patients with hypertension from the Korean Ambulatory Blood Pressure registry, all with valid ABP records. Two clinic BP targets were evaluated: an intensive target (< 130/80 mmHg) and a conventional target (< 140/90 mmHg). Controlled hypertension was defined as a 24-hour mean ABP < 130/80 mmHg in patients treated with antihypertensive drugs who had a clinic BP below these targets. Results: The prevalence of MUCH decreased significantly with the intensive target (15.5%) versus the conventional target (45.8%). In contrast, the prevalence of WUCH increased only marginally with the intensive targets. Most patients with MUCH (75.9%) had a clinic BP between 130/80 mmHg and 139/89 mmHg when MUCH was classified using the conventional target. For predicting MUCH, factors such as angiotensin-converting enzyme inhibitor use, body mass index, left ventricular mass index (LVMI), and use of ≥ 2 antihypertensive drugs were significant under the intensive target, whereas clinic BP, LVMI, alcohol intake, stroke history, and use of ≥ 2 antihypertensive drugs were relevant under the conventional target. Conclusion: Adopting the intensive clinic BP target (< 130/80 mmHg) notably reduced the prevalence of MUCH, with a slight increase in WUCH, offering a more accurate assessment of BP control than the conventional target.