title: White-coat hypertension as a cause of cardiovascular dysfunction.
abstract: BACKGROUND
  The increasing use of 24 h ambulatory blood pressure monitoring has allowed diagnosis of white-coat hypertension, in which blood pressures are higher on clinic measurements than on ambulatory monitoring. Treatment is not generally thought to be necessary for this disorder. However, there is evidence that patients with white-coat hypertension develop renal impairment and left ventricular hypertrophy. We undertook this study to assess whether white-coat hypertension, in the absence of cardiovascular structural abnormalities, is associated with cardiovascular functional abnormalities.
  
  
  METHODS
  Cardiovascular function was assessed by ultrasonography in three groups of patients classified as normotensive, persistently hypertensive, or white-coat hypertensive (23, 20, and 22 patients, respectively) on the basis of ambulatory blood pressure monitoring, carried out for 28 h with recordings taken every 15 min during the day and every 20 min during the night, and clinic measurements, made with a semi-automatic oscillometric device.
  
  
  RESULTS
  Similar abnormalities of diastolic left ventricular function were identified in the patients with persistent hypertension and those with white-coat hypertension; both groups differed in these indices from the normotensive group (E/A ratios 0.94 [SD 0.23], 1.06 [0.21], and 1.24 [0.31] respectively; ANOVA p < 0.005). In addition, the white-coat and persistently hypertensive groups, when compared with the normotensive group, showed similar abnormalities of elasticity, compliance, and stiffness (stiffness index 4.32 [1.90], 4.53 [1.38], and 3.27 [0.95] respectively; ANOVA p < 0.05) of the large arteries.
  
  
  CONCLUSIONS
  Functional cardiovascular abnormalities were identified in white-coat hypertensive patients who had no identifiable structural abnormalities. Such functional abnormalities can be reversed by antihypertensive treatment. We propose that patients with white-coat hypertension might benefit from antihypertensive treatment as well as those with persistent hypertension. This hypothesis should be addressed in prospective clinical trials.
authors.affiliation: Department of Medicine and Therapeutics, Western Infirmary, Glasgow, UK.
authors.forename: S K
authors.initials: SK
authors.lastname: Glen
authors.forename: H L
authors.initials: HL
authors.lastname: Elliott
authors.forename: J L
authors.initials: JL
authors.lastname: Curzio
authors.forename: K R
authors.initials: KR
authors.lastname: Lees
authors.forename: J L
authors.initials: JL
authors.lastname: Reid
mesh_terms: D000368:Aged; D001795:Blood Pressure Determination / Q000706:statistics & numerical data; D018660:Blood Pressure Monitoring, Ambulatory / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology*; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D010817:Physician-Patient Relations