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White-Coat Hypertension: the Neglected Subgroup in Hypertension

Cesare Cuspidi1,2, Marijana Tadic3, Giuseppe Mancia1

  • 1Department of Health Science, Clinica Medica, University of Milano-Bicocca, Milano, Italy.

Korean Circulation Journal
|July 4, 2018
PubMed

Insights

White coat hypertension (WCH), an increase in office blood pressure (BP) but normal out-of-office BP, carries an intermediate cardiovascular risk. This condition warrants attention due to its association with organ damage and potential for future cardiovascular events.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Preventive Medicine

Background:

  • White coat hypertension (WCH) is defined by elevated office blood pressure (BP) with normal ambulatory or home BP.
  • WCH represents a significant proportion (30-40%) of patients diagnosed with hypertension, particularly in mild cases or older individuals.
  • The prognostic significance and optimal management of WCH remain subjects of ongoing debate.

Purpose of the Study:

  • To review the prevalence, clinical correlates, and diagnostic challenges of WCH.
  • To examine the association between WCH and subclinical target organ damage.
  • To evaluate the cardiovascular (CV) risk, morbidity, and mortality associated with WCH and discuss therapeutic perspectives.

Main Methods:

  • This review synthesizes existing evidence on WCH, drawing significantly from the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study.
  • The PAMELA study is a longitudinal survey of the general population in the Milan area, Italy, over 20 years.
  • Analysis includes data on BP monitoring, CV risk factors, organ damage, and CV events.

Main Results:

  • Evidence suggests WCH is associated with increased CV risk factors and subclinical organ damage.
  • The cardiovascular risk associated with WCH is considered intermediate between sustained normotension and sustained hypertension.
  • Data indicate a link between WCH and an increased risk of cardiovascular events.

Conclusions:

  • WCH is not benign and represents an intermediate cardiovascular risk category.
  • Further research and consistent diagnostic criteria are needed for effective management.
  • Therapeutic strategies for WCH should be considered to mitigate long-term cardiovascular risk.

Keywords:
Anti-hypertensive treatmentCardiovascular prognosisWhite coat hypertension

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