title: Significance of white-coat hypertension in older persons with isolated systolic hypertension: a meta-analysis using the International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes population.
abstract: The significance of white-coat hypertension in older persons with isolated systolic hypertension remains poorly understood. We analyzed subjects from the population-based 11-country International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes database who had daytime ambulatory blood pressure (BP; ABP) and conventional BP (CBP) measurements. After excluding persons with diastolic hypertension by CBP (≥90 mm Hg) or by daytime ABP (≥85 mm Hg), a history of cardiovascular disease, and persons <18 years of age, the present analysis totaled 7295 persons, of whom 1593 had isolated systolic hypertension. During a median follow-up of 10.6 years, there was a total of 655 fatal and nonfatal cardiovascular events. The analyses were stratified by treatment status. In untreated subjects, those with white-coat hypertension (CBP ≥140/<90 mm Hg and ABP <135/<85 mm Hg) and subjects with normal BP (CBP <140/<90 mm Hg and ABP <135/<85 mm Hg) were at similar risk (adjusted hazard rate: 1.17 [95% CI: 0.87-1.57]; P=0.29). Furthermore, in treated subjects with isolated systolic hypertension, the cardiovascular risk was similar in elevated conventional and normal daytime systolic BP as compared with those with normal conventional and normal daytime BPs (adjusted hazard rate: 1.10 [95% CI: 0.79-1.53]; P=0.57). However, both treated isolated systolic hypertension subjects with white-coat hypertension (adjusted hazard rate: 2.00; [95% CI: 1.43-2.79]; P<0.0001) and treated subjects with normal BP (adjusted hazard rate: 1.98 [95% CI: 1.49-2.62]; P<0.0001) were at higher risk as compared with untreated normotensive subjects. In conclusion, subjects with sustained hypertension who have their ABP normalized on antihypertensive therapy but with residual white-coat effect by CBP measurement have an entity that we have termed, "treated normalized hypertension." Therefore, one should be cautious in applying the term "white-coat hypertension" to persons receiving antihypertensive treatment.
authors.affiliation: Heart Disease Prevention Program, Division of Cardiology, School of Medicine, University of California, Irvine, CA, USA.
authors.forename: Stanley S
authors.initials: SS
authors.lastname: Franklin
authors.forename: Lutgarde
authors.initials: L
authors.lastname: Thijs
authors.forename: Tine W
authors.initials: TW
authors.lastname: Hansen
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.forename: José
authors.initials: J
authors.lastname: Boggia
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kikuya
authors.forename: Kristina
authors.initials: K
authors.lastname: Björklund-Bodegård
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
authors.forename: Jørgen
authors.initials: J
authors.lastname: Jeppesen
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: Eamon
authors.initials: E
authors.lastname: Dolan
authors.forename: Tatiana
authors.initials: T
authors.lastname: Kuznetsova
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Stolarz-Skrzypek
authors.forename: Valérie
authors.initials: V
authors.lastname: Tikhonoff
authors.forename: Sofia
authors.initials: S
authors.lastname: Malyutina
authors.forename: Edoardo
authors.initials: E
authors.lastname: Casiglia
authors.forename: Yuri
authors.initials: Y
authors.lastname: Nikitin
authors.forename: Lars
authors.initials: L
authors.lastname: Lind
authors.forename: Edgardo
authors.initials: E
authors.lastname: Sandoya
authors.forename: Kalina
authors.initials: K
authors.lastname: Kawecka-Jaszcz
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Imai
authors.forename: Jiguang
authors.initials: J
authors.lastname: Wang
authors.forename: Hans
authors.initials: H
authors.lastname: Ibsen
authors.forename: Eoin
authors.initials: E
authors.lastname: O'Brien
authors.forename: Jan A
authors.initials: JA
authors.lastname: Staessen
mesh_terms: D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D014943:Global Health; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology; D015994:Incidence; D011159:Population Surveillance; D013599:Systole; D059466:White Coat Hypertension / Q000453:epidemiology* / Q000503:physiopathology