title: Clinic and ambulatory heart rate in sustained and white-coat hypertension.
abstract: BACKGROUND
  Sustained and white-coat hypertensives show hypertension in the office setting but different blood pressure values outside the clinical environment. So far, only a few incomplete data on heart rate are available inside and outside the clinical setting in these groups of patient. The aim of this study was to evaluate clinic and ambulatory heart in sustained hypertensives, white-coat hypertensives and normotensives.
  
  
  METHODS
  We selected 236 sustained hypertensives, 236 white-coat hypertensives and 236 normotensives matched for age, gender and body mass index, and with a similar occupation. The subjects had been submitted to clinic evaluation and the non-invasive monitoring of blood pressure and heart rate. White-coat hypertension was defined as clinic hypertension and a daytime blood pressure of less than 135/85 mmHg.
  
  
  RESULTS
  The clinic heart rate was significantly higher in sustained hypertensives and white-coat hypertensives than in normotensives (76 +/- 11 versus 75.5 +/- 10 versus 70 +/- 9 beats/min [bpm], respectively, P < 0.05). The daytime heart rate was significantly higher in sustained hypertensives than in white-coat hypertensives and normotensives (79.4 +/- 10 versus 74.6 +/- 8.5 versus 74.5 +/- 8.5 bpm, respectively, P < 0.05), as were the night-time heart rate (67 +/- 8.5 versus 63 +/- 8 versus 63 +/- 8 bpm, respectively, P < 0.05) and 24 h heart rate (76.3 +/- 9 versus 72 +/- 7.8 versus 72 +/- 8 bpm, respectively, P < 0.05). When men and women were analyzed separately, the same trend was observed.
  
  
  CONCLUSIONS
  The clinic heart rate is similar in sustained and white-coat hypertensives, but the ambulatory heart rate is lower in white-coat hypertensives. As ambulatory heart rate is more representative of 24 h heart rate load and may be a better indicator of the detrimental effect of heart rate, our findings suggest that white-coat hypertensives are at lower cardiovascular risk than sustained hypertensives.
authors.affiliation: Centro per lo Studio dell'Ipertensione Arteriosa, delle Dislipidemie e dell'Arteriosclerosi, Dipartimento di Medicina e Scienze dell'Invecchiamento, University Gabriele d'Annunzio, Chieti, Italy. pierdomenico@unich.it
authors.forename: S D
authors.initials: SD
authors.lastname: Pierdomenico
authors.forename: A
authors.initials: A
authors.lastname: Bucci
authors.forename: D
authors.initials: D
authors.lastname: Lapenna
authors.forename: F
authors.initials: F
authors.lastname: Cuccurullo
authors.forename: A
authors.initials: A
authors.lastname: Mezzetti
mesh_terms: D000328:Adult; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000209:etiology; D002940:Circadian Rhythm; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D012306:Risk; D012737:Sex Factors