The Cardiovascular Risk of White-Coat Hypertension

Area of Science:

• Cardiology
• Hypertension Research
• Epidemiology

Background:

• The prognostic significance of white-coat hypertension (WCH) and the white-coat effect (WCE) for cardiovascular disease (CVD) development is not fully understood.
• Existing research lacks comprehensive data on the long-term CVD outcomes associated with WCH.

Purpose of the Study:

• To investigate the association between WCH, WCE, and the incidence of CVD events.
• To compare CVD risk in individuals with WCH versus normotensive controls using ambulatory blood pressure monitoring.

Main Methods:

• Utilized data from the International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes (IDACO) across 11 cohorts.
• Compared 653 untreated WCH subjects with 653 age- and cohort-matched normotensive controls, assessing CVD risk using European Society Hypertension guidelines.
• Employed stepwise linear regression and Cox proportional hazards models for analysis, with a median follow-up of 10.6 years.

Main Results:

• Systolic WCE increased with age (3.8 mm Hg per decade) but was independent of CVD risk status.
• High-risk WCH subjects (≥3 risk factors, diabetes, or prior CVD) had a significantly higher incidence of CVD events (adjusted HR: 2.06) compared to matched controls.
• This elevated risk was primarily observed in older (≥60 years) high-risk WCH individuals (adjusted HR: 2.19), with no significant increase in low-risk WCH or older low-risk WCH groups.

Conclusions:

• The white-coat effect's magnitude is linked to aging, not directly to cardiovascular risk.
• For the majority of individuals, WCH does not confer increased CVD risk compared to age- and risk-adjusted normotensive individuals.
• Older, high-risk individuals with WCH represent a specific subgroup with a potentially elevated risk for cardiovascular events.