title: White-coat hypertension during coronary computed tomography angiography is associated with higher coronary atherosclerotic burden.
abstract: BACKGROUND
  White-coat hypertension (WCH) is a prevalent entity, which has been associated with an increased cardiovascular risk.
  
  
  OBJECTIVE
  Assess whether WCH is associated with a higher coronary atherosclerotic burden, evaluated by coronary computed tomography angiography (CCTA) and coronary artery calcium (CAC) scoring.
  
  
  METHODS
  A total of 1362 patients who performed CCTA and simultaneous CAC for the assessment of coronary artery disease (CAD) were prospectively enrolled in a single-center registry and divided into three groups: (A) patients with normal blood pressure (BP) (n=386); (B) patients with WCH (n=174; without a history of hypertension or antihypertensive medication, but with systolic BP ≥140 and/or diastolic BP ≥90 mmHg before examination acquisition); and (C) patients with hypertension (n=802). The following coronary atherosclerotic markers were evaluated: CAC above the 50th percentile (CAC>p50), prevalence of CAD (any plaque), and obstructive CAD (plaque with>50% stenosis).
  
  
  RESULTS
  Patients with WCH had a higher coronary atherosclerotic burden compared with patients with normal BP for all markers (30.5 vs. 19.4%, P=0.004 for CAC>p50; 50.6 vs. 36.8%, P=0.002 for CAD, any plaque; and 13.8 vs. 8.3%, P=0.045 for obstructive CAD). On multivariate analysis, WCH was an independent predictor of a CAC>p50 [odds ratio (OR) 1.563, 95% confidence interval 1.018-2.400, P=0.041], but not of the presence of CAD (any plaque) (OR 1.335, P=0.169) or obstructive CAD (OR 1.376, P=0.301).
  
  
  CONCLUSIONS
  In this registry of patients, WCH was an independent predictor of a CAC above the p50. It was also associated with higher other markers of coronary atherosclerotic burden, such as the presence of CAD on CCTA, compared with patients with normal BP.
authors: aHospital da Luz bHospital de Santa Cruz cCEDOC, Nova Medical School, Lisbon dHospital Santarém, Santarém, Portugal.
authors: Cátia
authors: C
authors: Costa
authors: Pedro
authors: P
authors: de Araújo Gonçalves
authors: António
authors: A
authors: Ferreira
authors: Maria L
authors: ML
authors: Pitta
authors: Hélder
authors: H
authors: Dores
authors: Nuno
authors: N
authors: Cardim
authors: Hugo
authors: H
authors: Marques
mesh_terms: D000368:Aged; D001794:Blood Pressure; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects* / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000473:pathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic; D011174:Portugal; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D059466:White Coat Hypertension / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology