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White coat effect in treated and untreated patients with high office blood pressure. Relationship with pulse wave
Albino Silveira1, Anabela Mesquita, João Maldonado
1Unidade Hipertensão e Risco Cardiovascular, Hospital Pedro Hispano, Matosinhos Unidade Farmacologia Clínica da Faculdade de Medicina do Porto.
Insights
The white coat effect in hypertension does not indicate target organ damage or treatment efficacy. Antihypertensive therapy does not improve ambulatory blood pressure or organ damage in white coat hypertension.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Biology
Background:
- The white coat effect (WCE), defined as elevated office blood pressure (BP) with normal ambulatory BP, is common in hypertensive patients.
- The association between WCE, target-organ damage, and the impact of antihypertensive therapy remains incompletely understood.
Purpose of the Study:
- To investigate the relationship between the white coat effect and target-organ damage (aortic stiffness and left ventricular mass index).
- To determine if antihypertensive therapy modifies this relationship in patients with white coat hypertension (WCH) and sustained hypertension (HT).
Main Methods:
- Cross-sectional evaluation of office BP, 24-h ambulatory BP monitoring (ABPM), carotid-femoral pulse wave velocity (PWV), and left ventricular mass index (LVMI).
- Comparison between WCH (n=88) and HT (n=115) groups, including treated and untreated subgroups.
- Longitudinal assessment of BP and PWV changes after >6 months of antihypertensive therapy in a subset of patients.
Main Results:
- The white coat effect intensity did not correlate with PWV or LVMI, while daytime BP significantly correlated with both.
- WCH patients exhibited lower PWV and LVMI compared to HT patients.
- Antihypertensive therapy reduced daytime BP and PWV in HT patients but not in WCH patients.
Conclusions:
- The white coat effect intensity does not reflect target-organ damage severity or antihypertensive treatment efficacy in WCH or HT.
- Antihypertensive therapy offers no benefit for ambulatory BP or target-organ damage in patients with white coat hypertension.
Objective:
To evaluate in hypertensive patients whether the white coat effect is associated with target-organ damage and whether it is modified by anti-hypertensive therapy.
Methods:
In a cross-sectional study we evaluated blood pressure (BP) measured in the office and by 24-h ambulatory blood pressure monitoring (ABPM), carotid-femoral pulse wave velocity (PWV) as an index of aortic stiffness, and left ventricular mass index (LVMI) in 88 subjects (aged 49 +/- 2 years) with white-coat hypertension (WCH, office BP > 140/90, daytime BP < 130/84 mmHg), 31 under antihypertensive therapy, 57 untreated, and in 115 patients with office and ambulatory hypertension (HT, aged 51 +/- 2 years, office BP > 140/90, daytime BP > 135/85), 65 under antihypertensive therapy, 50 untreated. In a longitudinal study in 15 patients with HT and in 11 patients with WCH we evaluated the influence of antihypertensive therapy (> 6 months) on office and ambulatory BP and on PWV.
Results:
The intensity of the white coat effect (office BP-daytime BP) was greater in WCH than in HT. Taking all subjects, the white coat effect did not correlate with PWV (r = 0.08, ns) or with LVMI (r = 0.01, ns), whereas daytime BP correlated significantly with PWV (r = 0.41, p < 0.01) and with LVMI (r = 0.32, p < 0.05). WCH subjects showed lower PWV and LVMI than HT subjects. Treated and untreated WCH, with similar office and daytime BP, showed similar values of PWV and LVMI. Treated and untreated HT showed similar office BP values but treated HT showed lower daytime BP and PWV values. In the longitudinal study, antihypertensive therapy significantly reduced daytime BP and PWV values in the 15 HTs, whereas in the 11 WCH it did not alter daytime BP or PWV values.
Conclusions:
1. In both WCH and HT (treated and untreated) the intensity of the white coat effect does not reflect either the severity of hypertension measured by target organ damage or the efficacy of antihypertensive treatment. 2. In WCH antihypertensive therapy does not improve either ambulatory BP values or damage to target organs.
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