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Is white coat hypertension associated with arterial disease or left ventricular hypertrophy?
M C Cavallini1, M J Roman, T G Pickering
1Department of Medicine, New York Hospital-Cornell Medical Center, New York 10021, USA.
Insights
White coat hypertension, unlike sustained hypertension, shows no significant target-organ damage. This suggests white coat hypertension may be benign, potentially not requiring medication.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Medicine
Background:
- White coat hypertension affects a significant portion of hypertensive individuals.
- The long-term prognostic implications of white coat hypertension remain unclear.
- Understanding organ damage is crucial for assessing hypertension risks.
Purpose of the Study:
- To compare target-organ damage in white coat hypertension versus sustained hypertension and normotension.
- To evaluate cardiac and carotid artery structure and function in different blood pressure groups.
- To determine if white coat hypertension is associated with adverse structural changes.
Main Methods:
- Comparison of 24 individuals with white coat hypertension against matched sustained hypertensive and normotensive groups.
- Assessment of left ventricular mass index and carotid artery intimal-medial thickness using ultrasonography.
- Evaluation of atherosclerotic plaque prevalence in all study groups.
Main Results:
- Left ventricular mass index was similar in white coat hypertensive and normotensive subjects, but higher in sustained hypertensives.
- Carotid artery intimal-medial thickness was significantly greater in sustained hypertensives compared to both other groups.
- Atherosclerotic plaques were more prevalent in sustained hypertensives than in white coat hypertensive or normotensive subjects.
Conclusions:
- Cardiac and carotid structures in white coat hypertension resemble those in normotensive individuals.
- Individuals with white coat hypertension show significantly less organ damage than those with sustained hypertension.
- White coat hypertension may be a benign condition, potentially not necessitating pharmacological intervention.
Abstract:
Although white coat hypertension may be present in 20% or more of hypertensive individuals, its prognostic significance is unknown. We compared prognostically relevant measures of target-organ damage among 24 individuals with white coat hypertension and age- and sex-matched groups of sustained hypertensive and normotensive subjects classified by clinical and 24-hour ambulatory blood pressures. Left ventricular and carotid artery structure and function were evaluated by ultrasonography. Left ventricular mass index was similar in white coat hypertensive (82 +/- 17 g/m2) and normotensive (78 +/- 15 g/m2) subjects but was higher in sustained hypertensive subjects (97 +/- 19 g/m2, P < .02 and P < .002, respectively). Similarly, carotid artery intimal-medial thickness was greater in the sustained hypertensive group (0.98 +/- 0.21 mm) than in the white coat hypertensive (0.84 +/- 0.16 mm, P < .05) and normotensive (0.76 +/- 0.18 mm, P < .001) groups. The prevalence of discrete atherosclerotic plaques was higher in the sustained hypertensive group (58%) than in the white coat hypertensive (25%, P < .05) and normotensive (21%, P < .02) groups. Cardiac and carotid structure in individuals with white coat hypertension resemble findings in normotensive subjects and differ significantly from those in age- and sex-matched sustained hypertensive subjects. These findings suggest that white coat hypertension may be a benign condition for which pharmacological intervention may not be necessary, a hypothesis that needs to be tested in longitudinal studies with clinical end points.