Interaction between white coat effect and hypertension on arterial stiffness

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.