Follow-up clinic and ambulatory blood pressure in untreated white-coat hypertensive patients (evaluation after 2-5 years).
BACKGROUND: It is still under debate whether subjects with persistently elevated clinic blood pressure but normal ambulatory blood pressure, [white-coat hypertensives (WCH)] have a higher propensity for further development of ambulatory hypertension. METHODS: We prospectively evaluated for 3.5 years (from 26 up to 59 months) the transition of clinic and ambulatory blood pressure values in 36 untreated subjects (17-65 years) with WCH (clinic blood pressure > 140/90 and awake ambulatory blood pressure < 132/84 mmHg and without any other major cardiovascular risk factors) and of 52 clinic and ambulatory normotensive subjects (clinic blood pressure < 140/90 mmHg and awake blood pressure < 132/84 mmHg, 24-61 years). RESULTS: Average values of clinic blood pressure, 24 h blood pressure and awake blood pressure values did not differ from baseline to the end of the follow-up period in both populations. Development of ambulatory hypertension occurred in four out of 36 (11%) subjects with WCH and in three out of 52 (6%) normotensives if defined by awake blood pressure >/= 140/90 mmHg and in eight out of 36 (22%) subjects with WCH and in eight out of 52 (15%) normotensives if defined by awake blood pressure >/= 132/84 mmHg, respectively. Patients who reached ambulatory hypertension had baseline awake blood pressure values within the upper quintile of distribution of blood pressure in their respective group. CONCLUSION: After an average of 3.5 years of follow-up, a transition to ambulatory hypertension occurred in a similar way in normotensives and subjects with WCH without any other cardiovascular risk. A small propensity for the development of sustained hypertension may affect patients with higher initial ambulatory blood pressure values. Although a slow evolution towards sustained hypertension cannot be excluded in subjects with WCH, these findings suggest that this transition might be similar to that in normotensive subjects.
Polónia
JJ
Unidade de Farmacologia Clinica, Portol Portugal.
Santos
AR
Gama
GM
Basto
F
Bettencourt
PM
Martins
LR