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Target organ status and serum lipids in patients with white coat hypertension
S D Pierdomenico1, D Lapenna, M D Guglielmi
1Centro per lo Studio e la Terapia dell' Ipertensione Arteriosa, University G. D'Annunzio, Chieti, Italy.
Insights
White coat hypertension shows no target organ damage compared to sustained hypertension. This suggests white coat hypertension may not require aggressive treatment, unlike sustained hypertension.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Biology
Background:
- White coat hypertension (WCH) is characterized by elevated office blood pressure (BP) but normal out-of-office BP.
- The long-term cardiovascular implications of WCH remain debated.
- Understanding target organ status in WCH is crucial for risk stratification.
Purpose of the Study:
- To compare target organ status and serum lipids in white coat hypertension (WCH) versus sustained hypertension (SH) and normotension.
- To assess cardiac, vascular, and renal parameters in these groups.
Main Methods:
- Three groups were studied: 50 SH, 25 WCH, and normotensives, matched for age, sex, BMI, and smoking.
- Methods included echocardiography (left ventricular mass index), carotid ultrasonography (intima-media thickness, plaques), forearm vascular resistance, and urinary albumin excretion.
- Serum lipid profiles were also analyzed.
Main Results:
- WCH patients had significantly lower left ventricular mass index, intima-media thickness, and forearm vascular resistance compared to SH patients.
- Urinary albumin excretion and prevalence of left ventricular hypertrophy and microalbuminuria were significantly lower in WCH than SH.
- No significant differences were found between WCH and normotensive groups for these parameters.
Conclusions:
- White coat hypertension is associated with significantly less target organ damage than sustained hypertension.
- Target organ status in white coat hypertension appears similar to that of normotensive individuals.
- These findings suggest WCH may represent a less severe hypertensive state.
Abstract:
Target organ status and serum lipids were investigated in white coat hypertension in comparison with sustained hypertension and normotension. We selected three groups balanced for sex, age, body mass index, and smoking habit: 50 sustained hypertensives (clinical hypertension and 24-hour ambulatory blood pressure > 135/85 mm Hg, a cutoff limit obtained from a normotensive population), 25 white coat hypertensives (clinical hypertension and 24-hour ambulatory blood pressure < 135/85 mm Hg), and normotensives. Subjects underwent echocardiographic examinations to assess left ventricular mass index, carotid ultrasonography to evaluate intima-media thickness and atherosclerotic plaques, venous occlusion plethysmography to record minimum forearm vascular resistance, and determinations of serum lipid profile and 24-hour urinary albumin excretion. Compared with sustained hypertensives, the white coat hypertensives had significantly lower values of left ventricular mass index (125.9 +/- 20 versus 97.6 +/- 11.5 g/m2, P < .05, intima-media thickness (0.85 +/- 0.18 versus 0.71 +/- 0.15 mm, P < .05), minimum forearm vascular resistance (2.33 +/- 0.11 versus 2.04 +/- 0.08 resistance units, P < .05), urinary albumin excretion values (15.1 +/- 13.8 versus 4.45 +/- 1.48 mg per 24 hours, P < .0001), prevalence of left ventricular hypertrophy (versus 4%, P < .002), intima-media thickening 28% versus 4%, P < .015), and microalbuminuria (22% versus 0%, P < .015). No significant difference, however, was observed between the white coat hypertensives and the normotensives. Serum lipid profile was similar in the white coat hypertensives and in the normotensives.(ABSTRACT TRUNCATED AT 250 WORDS)