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Cardiac damage in hypertensive patients with inverse white coat hypertension. Hospitalet study
Raquel Hernández del-Rey1, Pedro Armario, Montserrat Martín-Baranera
1Unit of Hypertension and Vascular Risk, Department of Internal Medicine, Consorci Sanitari de la Creu Roja a Catalunya, L'Hospitalet de Llobregat, Barcelona, Spain. Raquel.Hernandez@chcr.scs.es
Insights
Inverse white coat hypertension (IWCH) is linked to greater left ventricular mass in patients with essential hypertension. This finding highlights the importance of monitoring blood pressure outside the clinic to assess cardiac damage risk.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Imaging
Background:
- Limited research exists on ambulatory blood pressure (BP) and cardiac damage in essential hypertensive patients with inverse white coat hypertension (IWCH).
- Understanding IWCH is crucial for accurate hypertension management and risk stratification.
Purpose of the Study:
- To determine the frequency of IWCH in untreated grade 1-2 hypertension.
- To compare cardiac damage in patients with IWCH, white coat hypertension (WCH), and other hypertensive patients.
Main Methods:
- 211 patients with grade 1-2 hypertension were enrolled; 204 underwent 24-h ambulatory BP monitoring.
- IWCH defined as daytime BP exceeding office BP; WCH defined as daytime BP < 135/85 mmHg.
- Echocardiograms were used to assess left ventricular hypertrophy (LVH), defined as LVMI > or = 125 g/m2.
Main Results:
- IWCH was identified in 14% (29 patients) and WCH in 33% (68 patients).
- IWCH patients exhibited higher 24-h, daytime, and nighttime BP compared to other groups.
- Left ventricular mass was significantly greater in IWCH patients, even after adjusting for confounding factors.
Conclusions:
- Inverse white coat hypertension is independently associated with increased left ventricular mass in grade 1-2 hypertension.
- These findings underscore the clinical significance of IWCH in predicting cardiac damage.
Background:
Few studies have assessed the relationship between ambulatory blood pressure (BP) and cardiac damage in essential hypertensive patients with inverse white coat hypertension (IWCH).
Objectives:
To determine the frequency of IWCH in untreated grade 1-2 hypertension and to assess possible differences in cardiac damage among patients with IWCH, white coat hypertension (WCH) and the rest of patients with grade 1-2 hypertension.
Patients And Methods:
Two hundred and eleven patients with grade 1-2 hypertension were sequentially included. A good quality 24-h ambulatory BP monitoring was obtained in 204 patients (age: 41 +/- 12 years, 56% males). IWCH was defined as a daytime systolic and/or diastolic BP higher than diagnostic office systolic and/or diastolic BP, respectively. WCH was defined as a daytime BP < 135/85 mmHg. A good quality echocardiogram was obtained in 174 patients. We considered left ventricular hypertrophy a left ventricular mass index (LVMI) > or = 125 g/m2.
Results:
We found IWCH in 29 subjects (14%), and WCH in 68 (33%). Office BP in patients with IWCH was in an intermediate position between WCH and the rest of grade 1-2 hypertension patients. The IWCH patients showed 24-h, daytime and night-time BP higher than the other groups. Left ventricular mass was significantly greater in patients with IWCH than in the other grade 1-2 hypertension patients after adjusting for age, gender, body mass index, smoking and office BP (regression coefficient 28.14, 95%CI: 7.36-48.91).
Conclusion:
IWCH is independently associated with higher values of left ventricular mass in patients with grade 1-2 hypertension.