American Versus European Hypertension Guidelines: The Case of White Coat Hypertension

The impact of the 2017 American College Cardiology/American Heart Association guidelines on reclassification of white coat hypertension (WCH) and white coat uncontrolled hypertension (WUCH) phenotypes has not been thoroughly investigated, so far. The aim of the present analysis was to compare the prevalence rates of WCH and WUCH according to either 2018 European Society Hypertension/European Society Cardiology and 2017 ACC/AHA hypertension guidelines.

A large database of individual 24-hour ambulatory blood pressure (BP) recordings from untreated and treated hypertensive individuals with office BP ≥140 and/or 90 mm Hg was analyzed.

As many as 3,223 (39% men) out of 7,353 (47% men) fulfilled diagnostic criteria for WCH (n = 1,281) and WUCH (n = 1,942) according to the 2018 ESH/ESC guidelines (mean 24-hour BP <130/80 mm Hg), the prevalence rate being 17.4% and 26.4%, respectively. The corresponding figures according to the 2017 ACC/AHA guidelines (mean 24-hour BP <125/75 mm Hg) were 15.6 and 9.4%, respectively. Thus, a total of 1,378 patients (42.7%) either defined as WCH and WUCH by ESH/ESC guidelines, were classifiable as untreated sustained and uncontrolled sustained hypertensives by ACC/AHA guidelines.

The ACC/AHA reclassification of patients with office BP ≥140/90 mm Hg leads to a marked decrease in the prevalence of WCH/WUCH. This may have relevant clinical implications because the prognostic significance of these phenotypes is often ignored in clinical practice and, consequently, contributes to the high burden of cardiovascular diseases worldwide.