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Published on: June 27, 2025
Interaction between white coat effect and hypertension on arterial stiffness
Lin Jin1, Zhenyi Li1, Xinyi Li2,3
1Department of Ultrasound, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine.
Insights
The white coat effect (WCE) is linked to increased arterial stiffness and higher cardiovascular disease (CVD) risk in hypertensive individuals. This study found WCE independently predicts greater arterial stiffness, particularly in women.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Biology
Background:
- The white coat effect (WCE), characterized by elevated blood pressure in clinical settings, is a debated cardiovascular disease (CVD) risk factor.
- Existing research on the association between WCE, hypertension, and arterial stiffness remains inconsistent, necessitating further investigation.
Purpose of the Study:
- To investigate the interaction between WCE and hypertension concerning arterial stiffness.
- To determine if WCE is an independent predictor of arterial stiffness and CVD risk.
Main Methods:
- A cohort of 7584 participants, including controls and hypertensive individuals, was categorized into four groups: control, white coat hypertension (WCH), hypertension, and white coat uncontrolled hypertension (WUCH).
- Arterial stiffness was assessed using arterial velocity pulse index (AVI) and arterial pressure volume index (API) via cuff oscillometry.
- Logistic regression and restrictive cubic spline (RCS) analyses were employed to evaluate risk factors and the API-pulse pressure relationship.
Main Results:
- Participants with WUCH were older and exhibited higher pulse pressure (PP) and API compared to those with WCH.
- Both WCH/WUCH and API were identified as independent determinants of arterial stiffness and significant predictors of high CVD risk in multivariable analyses.
- A significant J-shaped relationship was observed between API and PP in both WCE and non-WCE individuals.
Conclusions:
- Individuals experiencing the white coat effect demonstrate increased peripheral arterial stiffness, with a more pronounced effect noted in women.
- The study confirms WCE as an independent risk factor associated with elevated CVD risk.
- A J-shaped association between arterial stiffness indices (API) and pulse pressure (PP) exists irrespective of WCE status.
Objective:
White coat effect (WCE) is a debated risk factor for cardiovascular diseases (CVD), and the current findings regarding its association with arterial stiffness in hypertension remain inconsistent. This study aimed to explore the interaction between WCE and hypertension on arterial stiffness.
Methods:
A total of 7584 participants, including 4679 controls and 2905 individuals with hypertension were enrolled and divided into four groups: control, white coat hypertension (WCH), hypertension, and white coat uncontrolled hypertension (WUCH). Arterial stiffness was assessed using arterial velocity pulse index (AVI) and arterial pressure volume index (API), measured through cuff oscillometry. Logistic regression was used to analyze the risk factors for high CVD risk. The association between API and pulse pressure (PP) was analyzed using restrictive cubic spline (RCS) analysis.
Results:
Participants with WUCH were older than those with WCH (63 vs. 58 years, p < 0.05), had higher PP (73 vs. 62 mmHg, P < 0.05), and a higher API (36 vs. 32, P < 0.05). In multivariable analysis, WCH/WUCH remained a determinant of API. After adjusting for confounding factors, API ( β = 1.046, P < 0.001), and WCH/WUCH ( β = 1.628, P < 0.001) were identified as independent influencing factors for high CVD risk. The RCS analysis of API and PP demonstrated a significant J-shaped relationship.
Conclusions:
Individuals with the WCE showed greater peripheral arterial stiffness, especially among women. A J-shaped relationship between API and PP was observed in both WCE and non-WCE individuals. WCE was independently associated with a higher CVD risk.
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