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White-coat hypertension and carotid artery atherosclerosis: a matching study
M F Muldoon1, P Nazzaro, K Sutton-Tyrrell
1Center for Clinical Pharmacology, University of Pittsburgh School of Medicine, PA 15260, USA. mfm10+@pitt.edu
Insights
Individuals with white coat hypertension, characterized by high clinic blood pressure but normal readings elsewhere, face similar atherosclerosis risks as those with persistent hypertension. These patients are not protected from cardiovascular complications.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Atherosclerosis Studies
Background:
- Clinic blood pressure (BP) is standard for assessing hypertensive vascular disease risk.
- Many patients exhibit high clinic BP but normal readings outside the clinic, termed "white coat" hypertension.
- The atherosclerotic risk for patients with white coat hypertension remains unclear.
Purpose of the Study:
- To investigate whether "white coat" hypertension poses an atherosclerosis risk comparable to persistent hypertension.
- To compare cardiovascular risk factors and carotid artery atherosclerosis in individuals with white coat hypertension, persistent hypertension, and persistent normotension.
Main Methods:
- Recruited community residents aged 40-70 without cardiovascular medication.
- Classified participants into persistent hypertension, white coat hypertension, or persistent normotension based on clinic and ambulatory BP (≥140/90 mm Hg).
- Matched male participants (n=40 per group) on race, clinic BP, and ambulatory BP to compare outcomes.
Main Results:
- Groups were similar in age, smoking, glucose, and lipid levels.
- White coat hypertension and persistent hypertension groups showed higher BMI, waist-hip ratio, and insulin levels than normotensive subjects.
- Carotid artery ultrasound revealed greater intimal-medial thickness and plaque index in white coat hypertension subjects, similar to persistent hypertension patients.
Conclusions:
- White coat hypertension patients are not protected from atherosclerosis.
- Atherosclerotic sequelae are comparable between white coat hypertension and persistent hypertension when clinic BP is similar.
- Elevated clinic blood pressure, even if transient, is associated with increased atherosclerosis risk.
Background:
Blood pressure (BP) measurements obtained in the clinic have long served as the basis for determining risk of hypertensive vascular disease, yet many patients with high BP in the physician's office are normotensive elsewhere. It remains unclear whether such patients with "white coat" hypertension elude the risk of atherosclerosis.
Methods:
Community residents 40 to 70 years of age and not receiving any cardiovascular medications were recruited to participate in a study of cardiovascular risk factors. On the basis of clinic and daytime ambulatory BP and a threshold criterion of 140/90 mm Hg, subjects were classified as having persistent hypertension, white-coat hypertension, or persistent normotension. One-to-one matching was conducted in male participants on the basis of race and BP. Subjects with persistent hypertension and white-coat hypertension were matched on clinic BP, and those with white-coat hypertension and normotension were matched on daytime ambulatory BP.
Results:
The 3 matched groups of men (n=40 in each group) were similar in age, smoking status, and fasting glucose and lipid levels. Compared with the normotensive subjects, subjects with either persistent or white-coat hypertension had greater mean body mass index, waist-hip ratio, and fasting insulin concentration. On the basis of standardized duplex ultrasound examination of the carotid arteries, mean maximal intimal-medial thickness and plaque index in subjects with white-coat hypertension were greater than among normotensive subjects and equal to that of the subjects with persistent hypertension.
Conclusion:
When compared with unmedicated individuals with comparable elevations in clinic BP, individuals with white-coat hypertension appear not to be protected from the atherosclerotic sequelae of hypertension.