ABC | Volume 113, Nº5, November 2019

Original Article Prevalence of Masked and White-Coat Hypertension in Pre-Hypertensive and Stage 1 Hypertensive patients with the use of TeleMRPA Weimar Kunz Sebba Barroso, 1, 2 A udes Diógenes Magalhães Feitosa, 3 Eduardo Costa Duarte Barbosa, 4 Roberto Dischinger Miranda, 5 Andréa Araújo Brandão, 6 Priscila Valverde Oliveira Vitorino, 7 Lúcio Paulo de Souza Ribeiro, 8 Marco Mota Gomes 9 Universidade Federal de Goiás - Programa de Pós-Graduação em Ciências da Saúde, 1 Goiânia, Goiás – Brazil Universidade Federal de Goiás - Liga de Hipertensão Arterial, 2 Goiânia, Goiás – Brazil Laboratório de Imunopatologia Keizo Asami - Universidade Federal de Pernambuco, 3 Recife, PE – Brazil Instituto de Cardiologia - Laboratório de Investigação Clínica (LIC), 4 Porto Alegre, RS – Brazil Escola Paulista de Medicina – Universidade Federal de São Paulo – Cardiogeriatria, 5 São Paulo, SP – Brazil Universidade do Estado do Rio de Janeiro – Cardiologia, 6 Rio de Janeiro, RJ – Brazil Escola de Ciências Sociais e da Saúde - Pontifícia Universidade Católica de Goiás - Ciências Sociais, 7 Goiânia, GO – Brazil Universidade Federal de Pernambuco - Centro de Informática, 8 Recife, PE – Brazil Centro Universitário CESMAC - Hospital do Coração, 9 Maceió, AL – Brazil Mailing Address: Weimar Kunz Sebba Barroso Souza • Universidade Federal de Goiás - Programa de Pós-Graduação em Ci ncias da Saúde - Avenida Universitária Hospital das Clínicas. Postal Code 74605-020, Goiânia, GO – Brazil E-mail: sebbabarroso@gmail.com , wsebba@uol.com.br Manuscript received November 23, 2018, revised manuscript February 27, 2019, accepted April 05, 2019 DOI: 10.5935/abc.20190147 Abstract Background: The diagnosis of arterial hypertension based on measurements of blood pressure in the office has low accuracy. Objective: To evaluate the prevalence of masked hypertension (MH) and white-coat hypertension through home blood pressure monitoring (HBPM) in pre-hypertensive and stage 1 hypertensive patients. Method: Retrospective study, of which sample consisted of individuals with BP ≥ 120/80 mmHg and < 160/100 mmHg at the medical office without the use of antihypertensivemedication andwho underwent exams on the HBPMplatformby telemedicine (TeleMRPA) between May 2017 and September 2018. The four-day MRPA protocol was used, with 24 measurements, using automated, validated, calibrated equipment with a memory function. Results: The sample consisted of 1,273 participants, of which 739 (58.1%) were women. The mean age was 52.4 ± 14.9 years, mean body mass index (BMI) 28.4 ± 5.1 kg/m 2 . The casual BP was higher than the HBPM in 7.6 mmHg for systolic blood pressure (SBP) and 5.2 mmHg for diastolic blood pressure (DBP), both with statistical significance (p < 0.001). There were 558 (43.8%) normotensive individuals; 291 (22.9%) with sustained hypertension; 145 (11.4%) with MH and 279 (21.9%) with white-coat hypertension (WCH), with a diagnostic error by casual BP in the total sample in 424 (33.3%) patients. In stage 1 hypertensive individuals, the prevalence of WCH was 48.9%; in prehypertensive patients, the prevalence of MH was 20.6%. Conclusion: MH and WCH have a high prevalence rate in the adult population; however, in prehypertensive or stage 1 hypertensive patients, the prevalence is higher. Out-of-office BP measurements in these subgroups should be performed whenever possible to prevent misdiagnosis. (Arq Bras Cardiol. 2019; 113(5):970-975) Keywords: Hypertension/diagnosis; Masked Hypertension; White Coat Hypertensin; Hypertension Self- Monitoring; Telemedicine. Introduction The prevalence of arterial hypertension (AH) in the Brazilian adult population is high and varies according to the studied population and the method of assessment (31% to 35.8%). 1 For this reason, the accurate diagnosis of the several scenarios related to blood pressure (BP) behavior is crucial for adequate stratification of cardiovascular risk, as well as for the definition of the best treatment strategies. 1,2 In this context, considerations should be given to the possibility of normotension, masked hypertension (MH), white-coat hypertension (WCH), and sustained AH. 3 MH is defined by the presence of normal BP in the office but high measurements outside of it; the WCH is defined by high values of BP in the office and normal values in the home measurements. It is noteworthy that MH, WCH and AH are highly prevalent and are related to an increase in cardiovascular morbidity and mortality. 4 Therefore, they should be investigated and diagnosed, and for this purpose, it is essential to use methods capable of monitoring BP outside the doctor's office environment. 5,6 Ambulatory (ABPM) or home (HBPM) BP monitoring can be used for home BP measurement, with the latter offering 970