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Prognostic Impact of Different Definitions of White-Coat Hypertension
Paolo Verdecchia1, Stefano Coiro2, Claudia Bartolini2
1Associazione Umbra Cuore e Ipertensione and Division of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy.
Insights
White-coat hypertension (WCH) carries low cardiovascular risk when defined by 24-hour ambulatory blood pressure (ABP) below 125/75 mmHg. Higher thresholds increase risks, highlighting the importance of precise WCH definitions for patient outcomes.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Epidemiology
Background:
- Variability in outcomes across white-coat hypertension (WCH) studies may stem from differing diagnostic definitions.
- Accurate WCH classification is crucial for predicting long-term cardiovascular risk.
Purpose of the Study:
- To investigate the long-term cardiovascular event and mortality risks associated with WCH using distinct 24-hour ambulatory blood pressure (ABP) thresholds.
- To clarify the prognostic implications of different WCH definitions.
Main Methods:
- A longitudinal study followed 3,153 individuals with office hypertension and 457 normotensive controls from 1986.
- Participants underwent 24-hour ABP monitoring; WCH was defined as average 24-hour ABP <130/80 mmHg or <125/75 mmHg.
- The primary outcome was a composite of major adverse cardiovascular events (MACE) and all-cause mortality over a mean 10.4-year follow-up.
Main Results:
- Compared to normotensives, individuals with WCH and 24-hour ABP <125/75 mmHg showed no increased risk of MACE (HR 0.94) or death (HR 1.37).
- However, WCH defined by 24-hour ABP <130/80 mmHg was associated with significantly higher MACE risk (HR 1.79) and all-cause mortality (HR 1.82).
Conclusions:
- Defining WCH using a stricter 24-hour ABP threshold (<125/75 mmHg) identifies individuals at low long-term risk for cardiovascular events and mortality.
- Elevated 24-hour ABP values even slightly above the <125/75 mmHg threshold are linked to increased cardiovascular risk, underscoring the clinical significance of precise diagnostic criteria.
Background:
Different definitions of white-coat hypertension (WCH) may explain its variable outcome across studies.
Methods:
In an Italian study started in 1986, we followed 3,153 people with (office blood pressure (BP) >=140/90 mmHg) and 457 without office hypertension for a mean of 10.4 years. None had previous cardiovascular disease. All underwent 24-h ambulatory BP (ABP) monitoring. We defined white-coat hypertension (WCH) as an average 24-h ABP < 130/80 mmHg or <125/75 mmHg. The primary outcome was a composite of major adverse cardiovascular events (MACE) and all-cause mortality.
Results:
Baseline office BP was 156/97 mmHg in people with and 127/81 mmHg without hypertension. At follow-up, MACE events were 344 and 23, and all-cause deaths were 318 and 24 in people with and without hypertension, respectively. Compared to normotensive group, MACE risk was not higher in people with WCH and 24-h ABP < 125/75 mmHg (hazard ratio (HR), 0.94; 95% confidence interval (CI), 0.42-2.10). Compared to normotensive group, MACE risk was higher in people with WCH and 24-h ABP < 130/80 mmHg (HR: 1.79; 95% CI, 1.07-2.29). All-cause death did not differ between the normotensive group and people with WCH and 24-h ABP < 125/75 mmHg (HR 1.37; 95% CI, 0.68-2.73), but it was higher than in the normotensive group when WCH was defined by a 24-h ABP < 130/80 mmHg (HR 1.82; 95% CI, 1.55-3.58).
Conclusions:
WCH defined by an average 24-h ABP < 125/75 mmHg identifies people at low risk of MACE and death in the long term. Even modestly above these threshold values, the risk associated with WCH increases.
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