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Metabolic risk factors in white coat hypertensives
E Marchesi1, G Perani, F Falaschi
1First Medical Clinic, University of Pavia, Italy.
Insights
White coat hypertension patients exhibit lower fasting and postload insulin levels, indicating a potentially better metabolic profile compared to sustained hypertensives. This suggests distinct prognostic significance for white coat hypertension.
Area of Science:
- Cardiovascular Medicine
- Metabolic Syndrome
- Hypertension Research
Background:
- Metabolic disturbances like hyperinsulinaemia and glucose intolerance are linked to essential hypertension and cardiovascular risk.
- Understanding the prognostic implications of white coat hypertension is crucial for patient management.
Purpose of the Study:
- To compare the metabolic profiles of white coat hypertension and sustained hypertension patients.
- To investigate the prognostic significance of white coat hypertension in newly detected hypertensive individuals.
Main Methods:
- Studied 84 newly detected hypertensive patients, excluding those with obesity, NIDDM, or target organ damage.
- Utilized ambulatory blood pressure monitoring and measured plasma glucose, insulin, lipids, and apolipoproteins.
- Categorized patients into white coat hypertension (n=20) and sustained hypertension groups.
Main Results:
- No significant differences in age, BMI, or waist-to-hip ratio were found between the groups.
- Plasma glucose and lipoprotein levels were similar in both white coat and sustained hypertensive patients.
- White coat hypertensives showed significantly lower fasting and postload insulin levels and a higher glucose/insulin rate.
Conclusions:
- White coat hypertension is associated with a more favorable metabolic profile, specifically lower insulin levels and improved insulin sensitivity.
- These findings suggest that white coat hypertension may have a different prognostic significance compared to sustained hypertension.
- Further research is warranted to explore the long-term cardiovascular outcomes in white coat hypertensive individuals.
Abstract:
Metabolic disturbances such as hyperinsulinaemia, dislipoproteinaemia and glucose intolerance are often associated with essential hypertension and markedly affect cardiovascular morbidity in hypertensive patients. In order to shed some light on the prognostic significance of white coat hypertension (raised clinic and normal ambulatory blood pressure), we compared the metabolic profile in a group of white coat and sustained previously untreated hypertensives. We studied 84 newly detected hypertensive patients (49 men, 35 women, 47 +/- 8 years, range 28-59 years). Subjects with obesity (BMI > 30), NIDDM and target organ damage were excluded. Ambulatory blood pressure monitoring was performed by SpaceLabs 90207-31. Total cholesterol and triglycerides, LDL-cholesterol, HDL-cholesterol (HDL-C) and subclasses HDL2 and HDL3 cholesterol as well as apolipoprotein A1 and B were measured in fasting plasma. Glucose and insulin were determined in fasting and postload (glucose 75 g plasma. Twenty patients (24%, 8 men and 12 women) were classified as white coat hypertensives. No differences in age, BMI and waist to hip ratio were observed between white coat and sustained hypertensive patients. Plasma glucose and lipoprotein levels were similar in the two groups. Fasting and postload insulin levels were significantly lower in white coat hypertensives (fasting insulin 7.1 +/- 2.9 vs. 12 +/- 8.6 microU/ml, P < 0.02; insulin 120 minutes 48 +/- 27 vs. 65 +/- 41 microU/ml, P < 0.05); glucose/insulin rate was higher in white coat than in sustained hypertensive patients (15 +/- 7 vs. 11 +/- 7, P = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)