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Reverse white-coat effect as an independent risk for microalbuminuria in treated hypertensive patients

Toako Kato1, Takeshi Horio, Mari Tomiyama

  • 1Division of Hypertension and Nephrology, Department of Medicine, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan.

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|December 5, 2006
PubMed
Abstract

Insights

Reverse white-coat hypertension, where blood pressure is normal in the clinic but high outside, is linked to increased microalbuminuria, a sign of early kidney damage in treated hypertension patients.

Area of Science:

  • Nephrology
  • Cardiology
  • Hypertension Research

Background:

  • White-coat hypertension (WCH) and its converse, reverse white-coat hypertension (RWCH), impact target organ damage.
  • RWCH, also known as masked hypertension, requires further investigation regarding its association with early renal damage.

Purpose of the Study:

  • To assess the hypothesis that RWCH is specifically associated with microalbuminuria in treated hypertensive patients.
  • To determine if RWCH is an independent predictor of early renal damage.

Main Methods:

  • 267 treated essential hypertensive patients were classified into three groups based on office and ambulatory blood pressure (BP) differences: white-coat effect (W), reverse white-coat effect (R), and normal (N).
  • Urinary albumin (U-Alb) to creatinine excretion ratio was measured to define microalbuminuria (U-Alb > or = 30 and < 300 mg/g Cr).

Main Results:

  • The RWCH group (R group) exhibited well-controlled office BP but elevated day-time BP compared to other groups.
  • U-Alb levels and microalbuminuria prevalence were significantly higher in the RWCH group than in the normal group.
  • Multivariate analysis identified RWCH as a significant predictor of microalbuminuria, independent of ambulatory BP levels (OR 2.63, P=0.02).

Conclusions:

  • Reverse white-coat hypertension is associated with a higher prevalence of microalbuminuria in treated hypertensive individuals.
  • RWCH may represent an independent risk factor for early renal damage in patients with hypertension.

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