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Cardiovascular risk in white-coat and sustained hypertensive patients
Hilde Celis1, Jan A Staessen, Lutgarde Thijs
1Study Coordinating Centre, Hypertension and Cardiovascular Rehabilitation Unit, Department of Molecular and Cardiovascular Research, University of Leuven, Leuven, Belgium. hilde.celis@med.kuleuven.ac.be
Insights
Patients with sustained hypertension face higher cardiovascular risks than those with white-coat hypertension. Ambulatory blood pressure, not office readings, independently predicts cardiovascular outcomes, highlighting the importance of accurate hypertension management.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Trials
Background:
- Differentiating between white-coat hypertension and sustained hypertension is crucial for accurate cardiovascular risk assessment.
- Previous studies have yielded conflicting results regarding the long-term prognosis of white-coat hypertension.
Purpose of the Study:
- To compare cardiovascular outcomes in patients with white-coat hypertension versus sustained hypertension.
- To determine the predictive value of ambulatory blood pressure (BP) versus office BP for cardiovascular events.
Main Methods:
- Analysis of data from the Ambulatory Blood Pressure Monitoring and Treatment of Hypertension (APTH) trial.
- Inclusion of 419 patients (326 sustained hypertension, 93 white-coat hypertension) with a median follow-up of 5.3 years.
- Utilizing multiple Cox regression to assess predictors of major cardiovascular events (death, myocardial infarction, stroke, heart failure).
Main Results:
- All 22 major cardiovascular events occurred in patients with sustained hypertension (rate 12.7 per 1000 patient-years).
- Daytime ambulatory BP, but not office BP at entry, independently predicted cardiovascular outcome after adjustment for covariables.
- Even after additional adjustment for office BP, daytime ambulatory BP remained a significant predictor of cardiovascular events.
Conclusions:
- Sustained hypertension is associated with a significantly worse cardiovascular prognosis compared to white-coat hypertension.
- Ambulatory BP monitoring is a superior predictor of cardiovascular events compared to office BP measurements.
- Accurate hypertension classification through ambulatory BP monitoring is vital for effective cardiovascular risk management.
Abstract:
We compared cardiovascular outcome between patients with white-coat and sustained hypertension who had previously participated in the Ambulatory Blood Pressure Monitoring and Treatment of Hypertension (APTH) trial. Baseline characteristics, including office and ambulatory blood pressure (BP), were measured during the 2-month run-in period of the APTH trial. During follow-up, information on the occurrence of major cardiovascular events (death, myocardial infarction, stroke and heart failure), achieved office BP and treatment status was obtained. At entry, 326 patients had sustained hypertension (daytime ambulatory BP > or = 140 mmHg systolic and/or > or = 90 mmHg diastolic) and 93 had daytime ambulatory BP below these limits and were classified as white-coat hypertensives. During 2088 patient-years of follow-up (median follow-up 5.3 years), all major cardiovascular events (n = 22) occurred in the patients with sustained hypertension (rate 12.7 per 1000 patient-years, p = 0.02 for between-group difference). Furthermore, multiple Cox regression confirmed that after adjustment for important covariables, daytime ambulatory BP--but not office BP at entry--significantly and independently predicted cardiovascular outcome. After additional adjustment for office BP, daytime ambulatory BP still predicted the occurrence of major cardiovascular events. Although white-coat hypertension was less frequently associated with antihypertensive drug treatment during follow-up, it carried a significantly better prognosis than sustained hypertension.