Is White Coat Hypertension Associated With Arterial Disease or Left Ventricular Hypertrophy?

TLDR

White coat hypertension is common, occurring in over 20 % of hypertensive patients, yet its prognostic significance remains unclear. The study compared target‑organ damage markers among 24 white coat hypertensive individuals with age‑ and sex‑matched sustained hypertensive and normotensive controls using clinical and 24‑hour ambulatory blood pressures. Left ventricular mass and carotid artery structure and function were assessed by ultrasonography, with participants classified by their clinical and ambulatory BP profiles. White coat hypertensives exhibited left ventricular mass and carotid intima‑media thickness similar to normotensives but lower than sustained hypertensives, with reduced plaque prevalence, suggesting a benign phenotype that may not require pharmacologic intervention.

Abstract

Abstract Although white coat hypertension may be present in 20% or more of hypertensive individuals, its prognostic significance is unknown. We compared prognostically relevant measures of target-organ damage among 24 individuals with white coat hypertension and age- and sex-matched groups of sustained hypertensive and normotensive subjects classified by clinical and 24-hour ambulatory blood pressures. Left ventricular and carotid artery structure and function were evaluated by ultrasonography. Left ventricular mass index was similar in white coat hypertensive (82±17 g/m 2 ) and normotensive (78±15 g/m 2 ) subjects but was higher in sustained hypertensive subjects (97±19 g/m 2 , P <.02 and P <.002, respectively). Similarly, carotid artery intimal-medial thickness was greater in the sustained hypertensive group (0.98±0.21 mm) than in the white coat hypertensive (0.84±0.16 mm, P <.05) and normotensive (0.76±0.18 mm, P <.001) groups. The prevalence of discrete atherosclerotic plaques was higher in the sustained hypertensive group (58%) than in the white coat hypertensive (25%, P <.05) and normotensive (21%, P <.02) groups. Cardiac and carotid structure in individuals with white coat hypertension resemble findings in normotensive subjects and differ significantly from those in age- and sex-matched sustained hypertensive subjects. These findings suggest that white coat hypertension may be a benign condition for which pharmacological intervention may not be necessary, a hypothesis that needs to be tested in longitudinal studies with clinical end points.