[White coat arterial hypertension and isolated systolic arterial hypertension: ultrasonography of the carotid arteries].
BACKGROUND
The prognosis of white coat hypertension is uncertain. The aim of this study was to evaluate the prevalence of atherosclerotic carotid lesions in subjects with white coat hypertension and clinical isolated systolic hypertension using 2D echo-color-doppler procedure.


METHODS
Patients were initially selected through the sphygmomanometric measurement of blood pressure and subsequently through 24-hour blood pressure monitoring. Fifty-four subjects with white coat hypertension were studied in comparison with either 60 normotensive subjects or 116 sustained isolated systolic arterial hypertensives. All patients underwent high-resolution B-mode echotomography of both carotid arteries, which made it possible to assess myointimal thickening and plaques. A thickness of > or = 0.95 mm, calculated as the mean of 5 measurements of the common carotid artery, 2.3 cm from the flow divider, was considered a sign of myointimal thickening, while plaques were represented by a focal thickening of > or = 2 mm, based on echogenic characteristics (hard, fibrous, mixed, soft and hemorrhagic) and site (common carotid, bifurcation, internal and external carotid).


RESULTS
Normal carotid arteries, carotid arteries with myointimal thickening, or carotid arteries with at least one plaque, were similar in subjects with white coat hypertension and in normotensives. Instead, as compared with subjects with white coat hypertension, sustained hypertensives showed a pattern of intimal-medial thickening (p = 0.04) with-one or more plaques (p = 0.005) on a much more frequent basis, while normal carotid arteries were less frequent (p = 0.0001). Plaques were most often localized at the common carotid artery and bifurcation and, less frequently, at the internal and external carotid arteries. Most often, the lesions were hard, less fibrous, mixed and soft.


CONCLUSIONS
White coat hypertensives with clinical isolated systolic hypertension may represent a low-risk group. Long-term prospective studies are required in order to obtain a definitive prognosis of white coat hypertension.
Pellegrino
L
L
Servizio di Cardiologia, Ospedale Civile San Camillo de Lellis, Manfredonia.
Prencipe
G
G
D018660:Blood Pressure Monitoring, Ambulatory; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D013599:Systole / Q000502:physiology
Ipertensione arteriosa da camice bianco ed ipertensione arteriosa sistolica isolata: studio ultrasonografico delle arterie carotidi.