[Relationship between blood pressure determination anxiety and hypertensive complications]

To assess the clinical significance of the reaction to blood pressure measurement, 1,013 (889 men) borderline to severe hypertensive patients, enrolled between 1984 and 1993, were studied. Their mean age (+/- SE) was 33.6 +/- 0.46 (range 16-75 years) and their mean office blood pressure (+/- SE) was 152.3 +/- 0.56/95.5 +/- 0.39 mmHg. All subjects underwent ambulatory blood pressure monitoring, ECG and fundoscopy. On the basis of the latter two tests a target organ damage score was calculated, from 0 (no abnormalities) to 5 (maximum severity). In 731 patients an echocardiogram was also performed. The white-coat effect was assessed by measuring the regression of office blood pressure on ambulatory blood pressure and calculating the residual office blood pressure. The subjects with high residual blood pressure showed a greater degree of age-adjusted target organ damage compared to those with intermediate or low residual blood pressure (systolic p < 0.0001; diastolic p = 0.04). Age-adjusted left ventricular mass was influenced by residual diastolic blood pressure (p < 0.0001). In a stepwise multiple regression analysis, where age, ambulatory blood pressure levels, sex and duration of hypertension were added to the model, residual blood pressure showed a relationship with the degree of target organ damage and left ventricular mass. In conclusion, the present results show that the white-coat-effect is not innocent, as it is associated with a high degree of cardiovascular abnormalities.