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Hypertension types defined by clinic and ambulatory blood pressure in 14 143 patients referred to hypertension clinics worldwide. Data from the ARTEMIS study

Omboni, Stefano; Aristizabal, Dagnovar; De la Sierra, Alejandro; Dolan, Eamon; Head, Geoffrey; Kahan, Thomas; Kantola, Ilkka; Kario, Kazuomi; Kawecka-Jaszcz, Kalina; Malan, Leoné; Narkiewicz, Krzysztof; Octavio, José A.; Ohkubo, Takayoshi; Palatini, Paolo; Siègelovà, Jarmila; Silva, Eglé; Stergiou, George; Zhang, Yuqing; Mancia, Giuseppe; Parati, Gianfrancoon behalf of ARTEMIS (international Ambulatory blood pressure Registry: TEleMonitoring of hypertension and cardiovascular rISk project) Investigators

doi: 10.1097/HJH.0000000000001074

Objective: The Ambulatory blood pressure Registry TEleMonitoring of hypertension and cardiovascular rISk project was designed to set up an international registry including clinic blood pressure (CBP) and ambulatory blood pressure (ABP) measurements in patients attending hypertension clinics in all five continents, aiming to assess different daily life hypertension types.

Methods: Cross-sectional ABP, CBP and demographic data, medical history and cardiovascular risk profile were provided from existing databases by hypertension clinics. Hypertension types were evaluated considering CBP (≥140/90 mmHg) and 24-h ABP (≥130/80 mmHg).

Results: Overall, 14 143 patients from 27 countries across all five continents were analyzed (Europe 73%, Africa 3%, America 9%, Asia 14% and Australia 2%). Mean age was 57 ± 14 years, men 51%, treated for hypertension 46%, cardiovascular disease 14%, people with diabetes 14%, dyslipidemia 33% and smokers 19%. The prevalence of hypertension was higher by CBP than by ABP monitoring (72 vs. 60%, P < 0.0001). Sustained hypertension (elevated CBP and ABP) was detected in 49% of patients. White-coat hypertension (WCH, elevated CBP with normal ABP) was more common than masked hypertension (elevated ABP with normal CBP) (23 vs. 10%; P < 0.0001). Sustained hypertension was more common in Europe and America and in elderly, men, obese patients with cardiovascular comorbidities. WCH was less common in Australia, America and Africa, and more common in elderly, obese women. Masked hypertension was more common in Asia and in men with diabetes. Smoking was a determinant for sustained hypertension and masked hypertension.

Conclusion: Our analysis showed an unbalanced distribution of WCH and masked hypertension patterns among different continents, suggesting an interplay of genetic and environmental factors, and likely also different healthcare administrative and practice patterns.

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aItalian Institute of Telemedicine, Varese, Italy

bSicor Clinical and Research Center, Medellín, Colombia

cDepartment of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Barcelona, Spain

dConnolly Hospital, Dublin, Ireland

eBaker IDI Heart and Diabetes Institute, Melbourne, Australia

fDepartment of Cardiology, Danderyd University Hospital, Stockholm, Sweden

gTurku University Hospital, Turku, Finland

hDivision of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan

iDepartment of Cardiology, Interventional Elektrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland

jHypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa

kDepartment of Hypertension and Diabetology, Hypertension Unit, Medical University of Gdańsk, Gdańsk, Poland

lExperimental Cardiology, Tropical Medicine Institute, Central University, Caracas, Venezuela

mDepartment of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan

nVascular Medicine, Department of Medicine, University of Padova, Padova, Italy

oDepartment of Physiotherapy

pDepartment of Sport Medicine and Rehabilitation, Medical Faculty, Masaryk University

qSt. Anne's University Hospital in Brno, Brno, Czech Republic

rInstituto de Investigacion y estudio de Enfermedades Cardiovasculares, Facultad de Medicina, Universidad del Zulia, Maracaibo, Venezuela

sThird University Department of Medicine, Hypertension Center, Sotiria Hospital, Athens, Greece

tDivisions of Hypertension and Biometrics, FuWai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Beijing, China

uDepartment of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano

vDepartment of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy

Correspondence to Stefano Omboni, MD, Clinical Research Unit, Italian Institute of Telemedicine, Via Colombera 29, Solbiate Arno, 21048 Varese, Italy. Tel: +39 0331 984176; e-mail:

Abbreviations: ABPM, ambulatory blood pressure monitoring; ANOVA, analysis of variance; ARTEMIS, Ambulatory blood pressure Registry TEleMonitoring of hypertension and cardiovascular rISk; BP, blood pressure; SD, standard deviation

Received 8 October, 2015

Revised 27 June, 2016

Accepted 11 July, 2016

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