Cardiovascular and renal events in uncomplicated mild hypertensive patients with sustained and white coat hypertension.
BACKGROUND
The prognostic value of white coat hypertension (WCH) in uncomplicated patients with mild hypertension is not yet completely clear. We investigated cardiovascular outcomes in patients with mild hypertension and without left ventricular hypertrophy, diabetes mellitus, and associated cardiovascular and renal disease, with sustained hypertension (SH) and WCH.


METHODS
The occurrence of fatal and nonfatal cardiovascular events was evaluated in 1038 patients with mild hypertension and 241 normotensive subjects. The presence of WCH was defined as clinic hypertension and daytime blood pressure <135/85 mm Hg.


RESULTS
During follow-up (4.5 +/- 2.3 years, range 0.5 to 9.2 years) the event rates per 100 patient-years in subjects with normotension, WCH, and SH were 0.27, 0.38, and 1.39, respectively. After adjustment for other covariates, Cox regression analysis showed that SH was an independent predictor of cardiovascular events (SH versus WCH, RR 5.17, 95% CI 2.04 to 13.1, P = 0 .001), whereas there was no significant difference between normotension and WCH (normotension versus WCH, RR 0.93, 95% CI 0.22 to 3.98, P = .92). At the end of follow-up, drug therapy was less frequent and intensive in WCH than in SH.


CONCLUSIONS
In this study of individuals with mild hypertension and without left ventricular hypertrophy, diabetes mellitus, and associated cardiovascular and renal disease, subjects with WCH, despite less frequent and intensive drug therapy, had a significantly better prognosis than those with sustained hypertension.
Dipartimento di Medicina e Scienze dell'Invecchiamento, Università "Gabriele d'Annunzio," Chieti, Italy. pierdomenico@unich.it
Sante D
SD
Pierdomenico
Domenico
D
Lapenna
Anna
A
Bucci
Angelo
A
Di Iorio
Matteo
M
Neri
Franco
F
Cuccurullo
Andrea
A
Mezzetti
D000328:Adult; D001795:Blood Pressure Determination / Q000009:adverse effects* / Q000379:methods*; D002318:Cardiovascular Diseases / Q000209:etiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000209:etiology*; D007674:Kidney Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D011379:Prognosis; D016016:Proportional Hazards Models