title: The white-coat effect is an independent predictor of myocardial ischemia in resistant hypertension.
abstract: White-coat hypertension (WCH), commonly found in pseudoresistant hypertension, does not pose higher cardiovascular risk than hypertensive status. However, when the decrease of the out-of-office blood pressure does not reach normal levels - the white-coat effect (WCE) - the repercussions are still obscure. We investigated the repercussions of the WCE in myocardial perfusion in resistant hypertension (RHTN). We enrolled 129 asymptomatic RHTN subjects - divided into WCE (n = 63) and non-WCE (n = 66) - to perform rest and stress myocardial perfusion scintigraphy and biochemical tests. Groups were equal regarding age, gender and body mass index. There was a high prevalence of WCE (49%). WCE was associated with higher prevalence of myocardial ischemia (49.2% vs 7.6%, p < 0.001), microalbuminuria (60.3% vs 36.4%, p = 0.01) and higher heart rate (72 [64-80] vs 64 [60-69], p < 0.001), compared with non-WCE patients. On an adjusted logistic regression, heart rate was considered a predictor of WCE (OR = 1.10, 95% CI 1.04-1.15; p < 0.001), but not MA (OR = 1.8, 95% CI 0.8-3.9; p = 0.15). On a second model of adjusted logistic regression, WCE was an independent predictor of myocardial ischemia (OR = 14.7, 95% CI 4.8-44.8; p < 0.001). We found a high prevalence of WCE in RHTN, and this effect may predict silent myocardial ischemia in this subset of hypertensive patients. In this group of hypertensives special attention should be given to the WCE.
authors.affiliation: Laboratory of Cardiovascular Pharmacology, Faculty of Medical Sciences, University of Campinas , Campinas, SP , Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Modolo
authors.forename: Natália
authors.initials: N
authors.lastname: Ruggeri Barbaro
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: de Faria
authors.forename: Andréa
authors.initials: A
authors.lastname: Rodrigues Sabbatini
authors.forename: Maria Ondina
authors.initials: MO
authors.lastname: Paganelli
authors.forename: Vanessa
authors.initials: V
authors.lastname: Fontana
authors.forename: Heitor
authors.initials: H
authors.lastname: Moreno
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D001795:Blood Pressure Determination; D018660:Blood Pressure Monitoring, Ambulatory; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D055414:Myocardial Perfusion Imaging; D011379:Prognosis; D059466:White Coat Hypertension / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D000959:Antihypertensive Agents
keywords: Myocardial ischemia; resistant hypertension; white-coat effect