Is white coat hypertension associated with arterial disease or left ventricular hypertrophy?
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.
Cavallini
M C
MC
Department of Medicine, New York Hospital-Cornell Medical Center, New York 10021, USA.
Roman
M J
MJ
Pickering
T G
TG
Schwartz
J E
JE
Pini
R
R
Devereux
R B
RB
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002339:Carotid Arteries / Q000473:pathology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D016277:Ventricular Function, Left