{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T04:00:55Z","timestamp":1772164855269,"version":"3.50.1"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"23","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2016,12,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Ambulatory blood pressure (ABP) is consistently superior to clinic blood pressure (CBP) as a predictor of cardiovascular morbidity and mortality risk. A common perception is that ABP is usually lower than CBP. The relationship of the CBP minus ABP difference to age has not been examined in the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Between 2005 and 2012, 888 healthy, employed, middle-aged (mean\u00b1SD age, 45\u00b110.4 years) individuals (59% female, 7.4% black, 12% Hispanic) with screening BP &lt;160\/105 mm\u2009Hg and not taking antihypertensive medication completed 3 separate clinic BP assessments and a 24-hour ABP recording for the Masked Hypertension Study. The distributions of CBP, mean awake ABP (aABP), and the CBP\u2212aABP difference in the full sample and by demographic characteristics were compared. Locally weighted scatterplot smoothing was used to model the relationship of the BP measures to age and body mass index. The prevalence of discrepancies in ABP- versus CBP-defined hypertension status\u2014white-coat hypertension and masked hypertension\u2014were also examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Average systolic\/diastolic aABP (123.0\/77.4\u00b110.3\/7.4 mm\u2009Hg) was significantly higher than the average of 9 CBP readings over 3 visits (116.0\/75.4\u00b111.6\/7.7 mm\u2009Hg). aABP exceeded CBP by &gt;10 mm\u2009Hg much more frequently than CBP exceeded aABP. The difference (aABP&gt;CBP) was most pronounced in young adults and those with normal body mass index. The systolic difference progressively diminished, but did not disappear, at older ages and higher body mass indexes. The diastolic difference vanished around age 65 and reversed (CBP&gt;aABP) for body mass index &gt;32.5 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      . Whereas 5.3% of participants were hypertensive by CBP, 19.2% were hypertensive by aABP; 15.7% of those with nonelevated CBP had masked hypertension.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Contrary to a widely held belief, based primarily on cohort studies of patients with elevated CBP, ABP is not usually lower than CBP, at least not among healthy, employed individuals. Furthermore, a substantial proportion of otherwise healthy individuals with nonelevated CBP have masked hypertension. Demonstrated CBP\u2212aABP gradients, if confirmed in representative samples (eg, NHANES [National Health and Nutrition Examination Survey]), could provide guidance for primary care physicians as to when, for a given CBP, 24-hour ABP would be useful to identify or rule out masked hypertension.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.116.023404","type":"journal-article","created":{"date-parts":[[2016,12,5]],"date-time":"2016-12-05T16:40:13Z","timestamp":1480956013000},"page":"1794-1807","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":77,"title":["Clinic Blood Pressure Underestimates Ambulatory Blood Pressure in an Untreated Employer-Based US Population"],"prefix":"10.1161","volume":"134","author":[{"given":"Joseph E.","family":"Schwartz","sequence":"first","affiliation":[{"name":"From Center for Behavioral Cardiovascular Health (J.E.S., D.S., S.G., T.G.P.) and Department of Psychiatry (R.S.), Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S., T.Y., S.G.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (M.M.B.); USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA (J.E.B., A.A.S.); and Department of..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew M.","family":"Burg","sequence":"additional","affiliation":[{"name":"From Center for Behavioral Cardiovascular Health (J.E.S., D.S., S.G., T.G.P.) and Department of Psychiatry (R.S.), Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S., T.Y., S.G.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (M.M.B.); USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA (J.E.B., A.A.S.); and Department of..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daichi","family":"Shimbo","sequence":"additional","affiliation":[{"name":"From Center for Behavioral Cardiovascular Health (J.E.S., D.S., S.G., T.G.P.) and Department of Psychiatry (R.S.), Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S., T.Y., S.G.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (M.M.B.); USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA (J.E.B., A.A.S.); and Department of..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joan E.","family":"Broderick","sequence":"additional","affiliation":[{"name":"From Center for Behavioral Cardiovascular Health (J.E.S., D.S., S.G., T.G.P.) and Department of Psychiatry (R.S.), Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S., T.Y., S.G.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (M.M.B.); USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA (J.E.B., A.A.S.); and Department of..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arthur A.","family":"Stone","sequence":"additional","affiliation":[{"name":"From Center for Behavioral Cardiovascular Health (J.E.S., D.S., S.G., T.G.P.) and Department of Psychiatry (R.S.), Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S., T.Y., S.G.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (M.M.B.); USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA (J.E.B., A.A.S.); and Department of..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joji","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"From Center for Behavioral Cardiovascular Health (J.E.S., D.S., S.G., T.G.P.) and Department of Psychiatry (R.S.), Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S., T.Y., S.G.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (M.M.B.); USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA (J.E.B., A.A.S.); and Department of..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Sloan","sequence":"additional","affiliation":[{"name":"From Center for Behavioral Cardiovascular Health (J.E.S., D.S., S.G., T.G.P.) and Department of Psychiatry (R.S.), Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S., T.Y., S.G.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (M.M.B.); USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA (J.E.B., A.A.S.); and Department of..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tyla","family":"Yurgel","sequence":"additional","affiliation":[{"name":"From Center for Behavioral Cardiovascular Health (J.E.S., D.S., S.G., T.G.P.) and Department of Psychiatry (R.S.), Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S., T.Y., S.G.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (M.M.B.); USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA (J.E.B., A.A.S.); and Department of..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven","family":"Grossman","sequence":"additional","affiliation":[{"name":"From Center for Behavioral Cardiovascular Health (J.E.S., D.S., S.G., T.G.P.) and Department of Psychiatry (R.S.), Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S., T.Y., S.G.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (M.M.B.); USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA (J.E.B., A.A.S.); and Department of..."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas G.","family":"Pickering","sequence":"additional","affiliation":[{"name":"From Center for Behavioral Cardiovascular Health (J.E.S., D.S., S.G., T.G.P.) and Department of Psychiatry (R.S.), Columbia University Medical Center, New York, NY; Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY (J.E.S., T.Y., S.G.); Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (M.M.B.); USC Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA (J.E.B., A.A.S.); and Department of..."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1983.03330440030027"},{"key":"e_1_3_3_3_2","volume-title":"Screening for High Blood Pressure in Adults: A Systematic Evidence Review for the US Preventive Services Task Force","author":"Piper MA","year":"2014","unstructured":"Piper MA, Evans CV, Burda BU, Margolis KL, O\u2019Connor E, Smith N, Webber E, Perdue LA, Bigler KD, Whitlock EP; US Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews.Screening for High Blood Pressure in Adults: A Systematic Evidence Review for the US Preventive Services Task Force. Rockville, MD: Agency for Healthcare Research and Quality; 2014."},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0b013e3282f97854"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.7326\/M15-2223"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1988.03720020027031"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/00004872-199816010-00005"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.HYP.0000170138.56903.7a"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.HYP.0000107251.49515.c2"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/00004872-199104000-00007"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/00004872-199816100-00004"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.HYP.34.4.818"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/0895-7061(95)00216-2"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/MBP.0b013e328346d603"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.114.03957"},{"key":"e_1_3_3_16_2","volume-title":"SF-36 Health Survey: Manual and Interpretive Guide","author":"Ware JE","year":"1993","unstructured":"Ware JE. SF-36 Health Survey: Manual and Interpretive Guide. Boston, MA: The Health Institute, New England Medical Center; 1993."},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/MBP.0b013e3280f813bc"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.hjh.0000431740.32696.cc"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000154900.76284.F6"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/0962280206074463"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2015.05.002"},{"key":"e_1_3_3_22_2","volume-title":"Statistical Methods for Rates and Proportions","author":"Fleiss JL","year":"1981","unstructured":"Fleiss JL. Statistical Methods for Rates and Proportions. 2nd ed. New York, NY: John Wiley; 1981.","edition":"2"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"e_1_3_3_24_2","volume-title":"Hypertension: Clinical Management of Primary Hypertension in Adults","author":"National Institute for Health and Care Excellence","year":"2011","unstructured":"National Institute for Health and Care Excellence. Hypertension: Clinical Management of Primary Hypertension in Adults. London, UK: National Institute for Health and Care Excellence; 2011."},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-131-8-199910190-00003"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0b013e3282fbcedf"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1038\/ajh.2008.221"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1038\/jhh.2014.9"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajh\/hpu241"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.09.007"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1097\/MBP.0000000000000054"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajh\/hpv157"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1992.00400160062012"},{"key":"e_1_3_3_34_2","first-page":"325","article-title":"The variability of measurements of casual blood pressure, I: a laboratory study.","volume":"30","author":"Armitage P","year":"1966","unstructured":"Armitage P, Rose GA. The variability of measurements of casual blood pressure, I: a laboratory study. Clin Sci. 1966;30:325\u2013335.","journal-title":"Clin Sci"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.299.24.2842"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.5888\/pcd13.150348"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.116.023404","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T02:54:27Z","timestamp":1715568867000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.116.023404"}},"subtitle":["Results From the Masked Hypertension Study"],"short-title":[],"issued":{"date-parts":[[2016,12,6]]},"references-count":35,"journal-issue":{"issue":"23","published-print":{"date-parts":[[2016,12,6]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.116.023404"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.116.023404","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.727069979.793526263","asserted-by":"object"}]},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,12,6]]},"assertion":[{"value":"2016-05-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-10-19","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-12-06","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}