White-coat hypertension in adults.
White-coat hypertension is defined by the coexistence of persistently high office blood pressure (BP) with normal self-measured or ambulatory blood pressure. The prognostic impact of white-coat hypertension is a subject of debate. Cardiovascular morbidity seems to be lower in white-coat hypertension than in ambulatory hypertension, and, according to some but not all studies, is not dissimilar between white-coat hypertension and clinical normotension. In a large collaborative study including individual data from four prospective cohort studies, the incidence of stroke tended to increase in the white-coat hypertension group in the long run, crossing the hazard curve of the ambulatory hypertension by the ninth year of follow-up. These data raise the hypothesis, to be tested in future studies, that white-coat hypertension might not be a benign condition for stroke in the long term. Further studies are needed in order to: (1) test whether white-coat hypertension is really a benign condition for stroke in the long term; (2) compare, in patients with white-coat hypertension, a regimen based on life-style measures without drugs and a standard regimen consisting of life-style measures with the possible addition of drugs. On the basis of current evidence, it is reasonable to suggest a treatment based on life-style measures in the low-risk stratum of patients with white-coat hypertension under the conditions of correct definition, absence of comorbid conditions and target-organ damage, and adequate follow-up
Department of Cardiovascular Disease, Hospital R. Silvestrini, Perugia, Italy.
Fabio
F
Angeli
Paolo
P
Verdecchia
Roberto
R
Gattobigio
Mariagrazia
M
Sardone
Gianpaolo
G
Reboldi
D000328:Adult; D001007:Anxiety / Q000503:physiopathology; D001795:Blood Pressure Determination / Q000523:psychology / Q000592:standards; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis*; D009819:Office Visits; D011379:Prognosis