The Cardiovascular Risk of White-Coat Hypertension.
The role of white-coat hypertension (WCH) and the white-coat-effect (WCE) in development of cardiovascular disease (CVD) risk remains poorly understood.



Using data from the population-based, 11-cohort IDACO (International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes), this study compared daytime ambulatory blood pressure monitoring with conventional blood pressure measurements in 653 untreated subjects with WCH and 653 normotensive control subjects.



European Society Hypertension guidelines were used as a 5-stage risk score. Low risk was defined as 0 to 2 risk factors, and high risk was defined as ≥3 to 5 risk factors, diabetes, and/or history of prior CVD events. Age- and cohort-matching was done between 653 untreated subjects with WCH and 653 normotensive control subjects.



In a stepwise linear regression model, systolic WCE increased by 3.8 mm Hg (95% confidence interval [CI]: 3.1 to 4.6 mm Hg) per 10-year increase in age, and was similar in low- and high-risk subjects with or without prior CVD events. Over a median 10.6-year follow-up, incidence of new CVD events was higher in 159 high-risk subjects with WCH compared with 159 cohort- and age-matched high-risk normotensive subjects (adjusted hazard ratio [HR]: 2.06; 95% CI: 1.10 to 3.84; p = 0.023). The HR was not significant for 494 participants with low-risk WCH and age-matched low-risk normotensive subjects. Subgroup analysis by age showed that an association between WCH and incident CVD events is limited to older (age ≥60 years) high-risk WCH subjects; the adjusted HR was 2.19 (95% CI: 1.09 to 4.37; p = 0.027) in the older high-risk group and 0.88 (95% CI: 0.51 to 1.53; p = 0.66) in the older low-risk group (p for interaction = 0.044).



WCE size is related to aging, not to CVD risk. CVD risk in most persons with WCH is comparable to age- and risk-adjusted normotensive control subjects.
Heart Disease Prevention Program, Division of Cardiology, School of Medicine, University of California-Irvine, Irvine, California. Electronic address: ssfranklinmd@gmail.com.
Stanley S
SS
Franklin
Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
Lutgarde
L
Thijs
Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan; Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
Kei
K
Asayama
Center for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Yan
Y
Li
Steno Diabetes Center, Gentofte and Research Center for Prevention and Health, Gentofte, Denmark.
Tine W
TW
Hansen
Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
José
J
Boggia
Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
Lotte
L
Jacobs
Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
Zhenyu
Z
Zhang
Tohoku University Graduate School of Pharmaceutical Science and Medicine, Sendai, Japan.
Masahiro
M
Kikuya
Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Cardiology, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
Kristina
K
Björklund-Bodegård
Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan; Tohoku University Graduate School of Pharmaceutical Science and Medicine, Sendai, Japan.
Takayoshi
T
Ohkubo
Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
Wen-Yi
WY
Yang
Department of Medicine, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
Jørgen
J
Jeppesen
Cambridge University Hospitals, Addenbrook's Hospital, Cambridge, United Kingdom.
Eamon
E
Dolan
Institute of Internal Medicine, Novosibirsk, Russian Federation.
Tatiana
T
Kuznetsova
First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland.
Katarzyna
K
Stolarz-Skrzypek
Department of Medicine, University of Padua, Padua, Italy.
Valérie
V
Tikhonoff
Institute of Internal Medicine, Novosibirsk, Russian Federation.
Sofia
S
Malyutina
Department of Medicine, University of Padua, Padua, Italy.
Edoardo
E
Casiglia
Institute of Internal Medicine, Novosibirsk, Russian Federation.
Yuri
Y
Nikitin
Tohoku University Graduate School of Pharmaceutical Science and Medicine, Sendai, Japan.
Lars
L
Lind
Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay.
Edgardo
E
Sandoya
First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland.
Kalina
K
Kawecka-Jaszcz
Faculty of Medicine, Charles University, Pilsen, Czech Republic.
Jan
J
Filipovský
Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan; Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
Yutaka
Y
Imai
Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan.
Ji-Guang
JG
Wang
Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland.
Eoin
E
O'Brien
Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Epidemiology, Maastricht University, Maastricht, the Netherlands.
Jan A
JA
Staessen
D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D014943:Global Health; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D059466:White Coat Hypertension / Q000453:epidemiology* / Q000503:physiopathology
ambulatory blood pressure monitoring; cardiovascular disease; epidemiology; white-coat effect