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Left ventricular mass and geometry in patients with established hypertension and white coat hypertension
A Høegholm1, K S Kristensen, L E Bang
1Department of Internal Medicine, County Central Hospital, Naestved, Denmark.
Insights
White coat hypertension patients show less cardiac hypertrophy than established hypertension patients. Ambulatory blood pressure, not office readings, predicts cardiac changes, suggesting white coat hypertension may not require drug treatment.
Area of Science:
- Cardiology
- Hypertension Research
- Clinical Medicine
Background:
- White coat hypertension (WCH) is characterized by elevated office blood pressure but normal out-of-office readings.
- Established hypertension (EH) involves consistently high blood pressure readings.
- Cardiac involvement, such as left ventricular hypertrophy, is a known complication of hypertension.
Purpose of the Study:
- To compare cardiac mass and geometry in patients with WCH versus EH.
- To determine the association between blood pressure measurement methods (office vs. ambulatory) and cardiac structural changes.
- To evaluate the clinical implications for treatment decisions in WCH.
Main Methods:
- Prospective study of 143 newly diagnosed hypertensive patients.
- Comparison of office blood pressure, 24-hour ambulatory blood pressure monitoring (ABPM), and echocardiography.
- Patients categorized into WCH (n=53) and EH (n=90) based on ABPM.
Main Results:
- Left ventricular mass index (LVMI) and relative wall thickness (RWT) were significantly higher in EH patients compared to WCH patients.
- Ambulatory blood pressure measurements, not office readings, were significantly associated with cardiac hypertrophy.
- A higher proportion of WCH patients (83%) had normal left ventricular dimensions compared to EH patients (61%).
Conclusions:
- White coat hypertensive patients exhibit less cardiac structural alteration than those with established hypertension.
- Ambulatory blood pressure monitoring is a better predictor of cardiac hypertrophy than office blood pressure measurements.
- WCH patients may be managed as normotensives, potentially avoiding pharmacological antihypertensive therapy.
Abstract:
This study was designed to compare the cardiac mass and geometry in white coat hypertensive patients and established hypertensive patients through the prospective comparison of office blood pressure, daytime ambulatory blood pressure, and echocardiographically determined left ventricular mass and cardiac geometry in consecutive patients. We studied 143 patients from general practice in an outpatient hypertension unit. The patients had newly diagnosed mild-to-moderate hypertension prior to the institution of pharmacological anti-hypertensive therapy. All patients had a diastolic office blood pressure above 90 mm Hg; 90 had a consistently elevated diastolic blood pressure (established hypertension), whereas 53 had an average daytime ambulatory blood pressure below 90 mm Hg (white coat hypertension). Left ventricular mass index was significantly higher in the group with established hypertension, 102.4 +/- 26.6 g/m2 (mean +/- SD) v 93.6 +/- 23.5 (P = .045). Relative wall thickness was likewise significantly higher, 0.36 +/- 0.07 v 0.33 +/- 0.06 (P = .004). There was no significant difference in left atrial dimension. In a multiple regression model the ambulatory measurements and not the office measurements were statistically significantly associated with the extent of cardiac hypertrophy. Further, 44/53 (83%) of the patients with white coat hypertension had normal left ventricular dimensions, versus only 55/90 (61%) of the patients with established hypertension (P = .033). Thus, white coat hypertensive patients display less cardiac involvement than patients with established hypertension, indicating that they should rather be treated as normotensives than as hypertensives, ie, not with pharmacological antihypertensive therapy.