(Circulation. 1998;98:1892-1897.)
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports |
Cardiovascular Outcome in White-Coat Versus Sustained Mild Hypertension
A 10-Year Follow-Up Study
From the Department of Cardiovascular Medicine, Northwick Park, and St Mark's Hospital NHS Trust and Institute for Medical Research, Harrow, Middlesex, UK.
Correspondence to Dr A. Lahiri, MB, BS, MSc, MRCP, FACC, FESC, Department of Cardiovascular Medicine, Northwick Park Hospital, Watford Rd, Harrow, Middlesex, HA1 3UJ, UK.
Background—The aim of this study was to compare the risk conferred by white-coat versus sustained mild hypertension for the development of cardiovascular disease.
Methods and Results—Patients (n=479) who underwent 24-hour intra-arterial ambulatory blood pressure monitoring on the basis of a persistently elevated clinic systolic blood pressure of 140 to 180 mm Hg were followed up for the development of subsequent cardiovascular events during a 9.1±4.2-year period. White-coat hypertension, defined as a clinic systolic blood pressure of 140 to 180 mm Hg associated with a 24-hour ambulatory systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg, was present in 126 patients, and the remainder had sustained mild hypertension. A subgroup of patients without complications underwent follow-up echocardiography and carotid ultrasound. White-coat hypertensives were younger (44±12 versus 52±10 years, respectively; P<0.001) and had a significantly lower incidence of cardiovascular events (1.32 versus 2.56 events per 100 patient-years, respectively; P<0.001) than sustained hypertensives. Multivariate analysis revealed age (P=0.002), sex (P=0.007), race (P=0.001), smoking (P=0.005), and the presence of white-coat hypertension (hazard ratio, 0.29; 95% CI, 0.09 to 0.90; P=0.04) to be independent predictors of subsequent cardiovascular events. Subgroup analysis in patients without complications revealed a lower incidence of left ventricular hypertrophy and lesser degrees of carotid hypertrophy in the white-coat group.
Conclusions—These findings indicate a relatively benign outcome in white-coat hypertension compared with sustained mild hypertension.
Key Words: hypertension • prognosis • hypertrophy • cardiovascular diseases • carotid arteries
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