Short-Term 24-h Systolic Blood Pressure Variability and Subclinical Target-Organ Damage in White-Coat Hypertension: A...

To compare subclinical target-organ damage (TOD) across normotension (NT), white-coat hypertension (WCH), and mild-to-moderate hypertension (HT), and examine the association of 24-h systolic blood pressure (SBP) variability with concurrent TOD in untreated WCH.

This single-center retrospective cross-sectional study included 267 hospitalized participants who underwent ambulatory blood pressure monitoring between 2012 and 2021 (91 NT, 93 WCH, 83 HT). TOD markers were compared across groups. Within WCH, multivariable models assessed 24-h SBP variability in relation to any TOD, left ventricular hypertrophy (LVH), left ventricular mass index (LVMI), and microalbuminuria (MA), adjusting for age, sex, body mass index, and 24-h mean SBP.

Any TOD occurred in 26.4%, 52.7%, and 71.1% of NT, WCH, and HT participants, respectively (P<0.001). Within WCH, any TOD occurred in 35.5%, 64.5%, and 58.1% across increasing variability tertiles; the unadjusted between-tertile comparison was not statistically significant (P=0.056). Continuous 24-h SBP variability was associated with any TOD (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.05-1.52), LVH (OR 1.30, 95% CI 1.08-1.60), LVMI (β=2.23 g/m², 95% CI 0.33-4.12), and log-transformed MA (β=0.105, 95% CI 0.052-0.157). The area under the receiver operating characteristic curve was 0.613 for the base model and 0.678 after adding 24-h SBP variability, with better overall fit of the extended model (likelihood-ratio P=0.009).

WCH showed an intermediate prevalence of any TOD between NT and mild-to-moderate HT. Within WCH, higher 24-h SBP variability was associated with concurrent TOD after accounting for 24-h mean SBP and basic clinical factors, and may provide Supplementary Information when interpreted alongside mean ambulatory blood pressure. These single-center cross-sectional findings do not establish temporal or causal relationships and require confirmation in prospective multicenter studies.