Korean Circ J.  2018 Jul;48(7):552-564. 10.4070/kcj.2018.0167.

White-Coat Hypertension: the Neglected Subgroup in Hypertension

• Cuspidi C
• Tadic M
• Mancia G
• Grassi G

• KMID: 2414891
• DOI: http://doi.org/10.4070/kcj.2018.0167

Abstract

The clinical prognostic importance of white coat hypertension (WCH), that is, the clinical condition characterized by an increase of office but a normal ambulatory or home blood pressure (BP) is since a long time matter of considerable debate. WCH accounts for a consistent portion of hypertensive patients (up to 30-40%), particularly when hypertension is mild or age is more advanced. Although scanty and inconsistent information is available on the response of office and out-office BP to antihypertensive treatment and the cardiovascular (CV) protection provided by treatment, an increasing body of evidence focusing on the association of WCH with CV risk factors, subclinical cardiac and extra-cardiac organ damage and, more importantly, with CV events indicates that the risk entailed by this condition is intermediate between true normotension and sustained hypertension. This review will address a number of issues concerning WCH with particular attention to prevalence and clinical correlates, relation with subclinical target organ damage and CV morbidity/mortality, therapeutic perspectives. Several topics covered in this review are based on data acquired over the past 20 years by the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study, a longitudinal survey performed by our group on the general population living in the surroundings of Milan area in the north part of Italy.

Keyword

White coat hypertension; Cardiovascular prognosis; Anti-hypertensive treatment

MeSH Terms

Blood Pressure
Humans
Hypertension*
Italy
Longitudinal Studies
Prevalence
Risk Factors
White Coat Hypertension

Figure

• 

  Figure 1 Mean values of (A) BMI, (B) total cholesterol, (C) plasma triglycerides and (D) glucose in NT, WCHT and in established HT recruited in the PAMELA study. The progressive and significant increase in anthropometric and metabolic variables was evident both when the blood pressure data were analyzed as office vs. 24 hours and as office vs. home.7)HT = hypertensives; NT = normotensives; PAMELA = Pressioni Arteriose Monitorate E Loro Associazioni; WCHT = white coat hypertensives.*Refer to the statistical significance (p<0.01) of the values recorded in the different groups.

• 

  Figure 2 Mean values of MSNA uncorrected (A) or corrected (B) for heart rate in NT and in patients with WCHT and EHT.14)EHT = established hypertensives; MSNA = muscle sympathetic nerve traffic; NT = normotensives; WCH = white coat hypertensives.*,†Refer to the statistical significance (*p<0.05, †p<0.01) of the values recorded in the different groups.

• 

  Figure 3 Incidence of “new” hypertension in NT and in patients with WCHT, defined by 24-hour (A) or home (B) in the PAMELA study. p<0.01 between values observed in the 2 different groups.18)NT = normotensives; PAMELA = Pressioni Arteriose Monitorate E Loro Associazioni; WCHT = white coat hypertensives.

• 

  Figure 4 Kaplan-Meier curves for CV mortality in NT, WCH, and sustained HT. WCH was defined by an office BP elevation and ambulatory (24 hours) or home BP normality. NT and sustained HT were defined by normality or elevation of all 3 BPs, respectively. Average FU was 16 years.29)BP = blood pressure; CV = cardiovascular; FU = follow-up; HT = hypertensives; NT = normotensives; WCH = white coat hypertension.

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