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White-Coat Isolated Systolic Hypertension Is a Risk Factor for Carotid Atherosclerosis

Efstathios Manios1, Fotios Michas2, Kimon Stamatelopoulos2

  • 1Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece. stathismanios@yahoo.gr.

Journal of Clinical Hypertension (Greenwich, Conn.)
|August 3, 2016
PubMed

Insights

Isolated systolic white-coat hypertension (WCH) is linked to increased carotid artery intima-media thickness (CCA-IMT), suggesting a higher cardiovascular risk. Other WCH types show varying associations with CCA-IMT compared to hypertension and normotension.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Hypertension Research

Background:

  • The clinical significance of white-coat hypertension (WCH) is debated.
  • WCH is defined as elevated blood pressure (BP) in a clinical setting but normal BP during ambulatory monitoring.
  • Different WCH phenotypes may have distinct cardiovascular implications.

Purpose of the Study:

  • To assess the association between isolated systolic WCH, isolated diastolic WCH, and systolic/diastolic WCH with common carotid artery intima-media thickness (CCA-IMT).
  • To compare CCA-IMT values across WCH subgroups and other BP phenotypes (hypertension, normotension).

Main Methods:

  • 1382 patients underwent 24-hour ambulatory BP monitoring and carotid artery ultrasonography.
  • WCH was categorized into isolated systolic, isolated diastolic, and systolic/diastolic based on office BP elevation.
  • CCA-IMT measurements were analyzed in relation to BP phenotypes.

Main Results:

  • Patients with isolated systolic WCH exhibited significantly higher CCA-IMT (0.737 mm) than those with isolated diastolic WCH (0.685 mm).
  • CCA-IMT in isolated systolic WCH was nonsignificantly greater than in systolic/diastolic WCH (0.708 mm).
  • Isolated systolic WCH showed CCA-IMT similar to hypertension; isolated diastolic WCH was similar to normotension; systolic/diastolic WCH indicated intermediate risk.

Conclusions:

  • Isolated systolic white-coat hypertension is associated with increased subclinical atherosclerosis, indicated by higher CCA-IMT.
  • This finding suggests that isolated systolic WCH may represent a higher cardiovascular risk profile compared to other WCH subtypes.
  • WCH classification is crucial for risk stratification, with isolated systolic WCH warranting closer monitoring.

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