Is white-coat hypertension a risk factor for carotid atherosclerosis? A review and meta-analysis

Abstract

The association of white-coat hypertension (WCH) with target organ damage is still debated; in particular, the relationship of this blood pressure phenotype with subclinical vascular damage remains controversial. Thus, we carried out a systematic review and meta-analysis to provide updated information on carotid structural changes in WCH. Studies were identified using the following search terms: 'white coat hypertension', 'isolated clinic hypertension', 'carotid artery', 'carotid atherosclerosis', 'carotid intima-media thickness', 'carotid damage', 'carotid thickening'. Full articles published in the English language in the last two decades reporting studies on adults were considered. A total of 3478 untreated patients, 940 normotensive (48% men), 666 WCH (48% men), and 1872 hypertensive individuals (57% men) included in 10 studies, were analyzed. Common carotid intima-media thickness (IMT) showed a progressive increase from normotensive (718±36 μm) to WCH (763±47 μm, standardized mean difference 0.54±0.13, P<0.01) and to hypertensive patients IMT (817±47 μm, standardized mean difference 0.45±0.14, P<0.01). After assessing data for publication bias, only the difference between normotensive and WCH patients remained significant. Our meta-analysis documents that common carotid IMT, a prognostically validated marker of vascular damage, is greater in WCH patients than in true normotensive individuals and is not different from sustained hypertensives. This finding supports the concept that WCH is not an entirely benign condition.

Left atrial volume and function in patients with white-coat hypertension assessed by real-time three-dimensional echocardiography

“…This may lead to an increase in negative health outcomes over time. A recent meta-analysis of 10 studies reported that carotid atherosclerosis was significantly increased in patients with WCH compared with normotensive individuals [38]. In addition, although we did not detect a significant difference, one meta-analysis reported a significant increase in LV mass in patients with WCH compared with those with normal BP [1].…”

Adverse Prognostic Value of Persistent Office Blood Pressure Elevation in White Coat Hypertension

“…It appears from the present study that in WCH office BP predicts, together with other factors, long-term outcome and that its elevation contributes to the increased risk of cardiovascular events 15 as well as to the higher prevalence of subclinical cardiac and vascular damage reported for this condition in several studies. 13,[19][20][21]26,27,36,37 The following additional points deserve mention. One, compared with individuals in whom WCH was unstable, stable WCH was characterized by an older age, a greater body mass index, an increased left ventricular mass, and higher serum cholesterol and glucose values.…”

“…[2][3][4][5] This is because although in several studies and meta-analyses WCH has been reported to have a cardiovascular risk similar or not significantly greater than that of normotensive individuals, [6][7][8][9][10][11][12] in other studies the risk of this condition in untreated or treated patients has been found to be less than that of true hypertensive but greater than that of normotensive individuals. [13][14][15][16][17][18] Individual studies and meta-analyses have also reported that compared with normotensive controls subjects with WCH exhibit (1) a higher prevalence of overweight or obesity, dyslipidemias, diabetes mellitus, or an impaired fasting plasma glucose state than normotensive controls, 1 (2) a greater prevalence of asymptomatic organ damage [19][20][21] with documented prognostic significance, [22][23][24][25] and (3) an increased risk of developing true hypertension or diabetes mellitus. 26,27 Stratifying cardiovascular risk within the WCH categories is of obvious clinical importance because higher risk levels may justify the decision to adopt a closer follow-up as well as to start antihypertensive drug treatment.…”

Enhanced Risk of Carotid Atherosclerosis Associated With White‐Coat Hypertension

“…We ourselves have recently performed a systematic review and meta‐analysis in order to provide updated information on carotid structural changes in WCH . A total of 3478 untreated patients (940 normotensive [48% men], 666 WCH [48% men], and 1872 hypertensive individuals [57% men]) from 10 studies were analyzed.…”