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Cardiovascular outcome in white-coat versus sustained mild hypertension: a 10-year follow-up study

R S Khattar1, R Senior, A Lahiri

  • 1Department of Cardiovascular Medicine, Northwick Park, and St Mark's Hospital NHS Trust and Institute for Medical Research, Harrow, Middlesex, UK.

Circulation
|November 3, 1998
PubMed

Insights

White-coat hypertension poses a lower cardiovascular disease risk than sustained mild hypertension. This study found white-coat hypertensives experienced fewer events and less organ damage.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Preventive Medicine

Background:

  • Hypertension is a major risk factor for cardiovascular disease (CVD).
  • Differentiating between white-coat hypertension and sustained hypertension is crucial for risk assessment.
  • Previous studies have yielded conflicting results on the long-term prognosis of white-coat hypertension.

Purpose of the Study:

  • To compare the cardiovascular disease risk associated with white-coat hypertension versus sustained mild hypertension.
  • To identify predictors of cardiovascular events in patients with elevated clinic blood pressure.

Main Methods:

  • 479 patients with elevated clinic systolic blood pressure (140-180 mm Hg) underwent 24-hour ambulatory blood pressure monitoring.
  • Patients were followed for a mean of 9.1 years for cardiovascular events.
  • Subgroup analysis included echocardiography and carotid ultrasound to assess organ damage.

Main Results:

  • White-coat hypertension (elevated clinic BP, normal ambulatory BP) was diagnosed in 126 patients.
  • White-coat hypertensives were younger and had a significantly lower incidence of CVD events (1.32 vs. 2.56 events per 100 patient-years) compared to sustained hypertensives.
  • White-coat hypertension was an independent predictor of fewer cardiovascular events (HR, 0.29; P=0.04), with less left ventricular and carotid hypertrophy observed.

Conclusions:

  • White-coat hypertension is associated with a relatively benign prognosis compared to sustained mild hypertension.
  • These findings support a less aggressive management approach for white-coat hypertension.
  • Further research may clarify the optimal monitoring and treatment strategies for different hypertensive phenotypes.
Abstract

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