Reverse white-coat effect as an independent risk for left ventricular concentric hypertrophy in patients with treated essential hypertension

Abstract

Recent studies have shown that the converse phenomenon of white-coat hypertension called 'reverse white-coat hypertension' or 'masked hypertension' is associated with poor cardiovascular prognosis. We assessed the hypothesis that this phenomenon may specifically influence left ventricular (LV) structure in treated hypertensive patients. A total of 272 outpatients (mean age, 65 years) with chronically treated essential hypertension and without remarkable white-coat effect were enrolled. Patients were classified into two groups according to office and daytime ambulatory systolic blood pressure (SBP); that is subjects without (Group 1: office SBP Xdaytime SBP, n ¼ 149) and with reverse white-coat effect (Group 2: office SBPodaytime SBP, n ¼ 123). LV mass index and relative wall thickness were echocardiographically determined. In all subjects, LV mass index and relative wall thickness were positively correlated with daytime and 24-h SBP, but not with office SBP. In addition, these two indices were inversely correlated with office -daytime SBP difference. LV mass index (136731 and 115728 g/m 2 , mean7s.d.) and relative wall thickness (0.4970.09 and 0.4670.07) were significantly greater in Group 2 than in Group 1. As for LV geometric patterns, Group 2 had a significantly higher rate of concentric hypertrophy compared with Group 1 (48 and 28%). Multivariate analyses revealed that the presence of reverse white-coat effect was a predictor for LV concentric hypertrophy, independent of age, sex, hypertension duration, antihypertensive treatment and ambulatory blood pressure levels. Our findings demonstrate that reverse white-coat effect is an independent risk factor for LV hypertrophy, especially concentric hypertrophy, in treated hypertensive patients.

Impact of masking effect on subclinical carotid atherosclerosis in normotensives and untreated masked hypertensive and hypertensive patients

“…Two studies suggested that ME is an independent risk factor for target organ damage in treated hypertensive patients [2,3]. Tomiyama et al [2] showed that systolic ME is an independent risk factor for left ventricular concentric hypertrophy exclusively in treated hypertensive patients.…”

Association of insulin-like growth factor-1 receptor gene polymorphisms with left ventricular mass and geometry in essential hypertension

“…11,12 Echocardiographic parameters were measured by the consensus of two experienced investigators who were blinded to the clinical data of the subjects. Measurements, such as interventricular septal thickness (IVSTd), posterior wall thickness (PWTd), LV diameter at end-diastole (LVDd) and LV diameter at end-systole (LVDs).…”

White coat hypertension

“…8 Skorašnje studije su pokazale da je reverzna HBM važan prediktor u razvoju hipertro je leve komore. 9 Bolesnici sa drugim stadijumom arterijske hipertenzije imaju značajno češću pojavu cerebrovaskualrnih dogadjaja nego osobe sa nižim krvnim pritiskom a veruje se da bi osnov naglog poremećaja cerebralne cirkulacije mogao biti posledica dejstva pulsnog talasa, koji se prenosi duž aterijskih krvnih sudova. 10 Postoji saglasje da HBM ne treba lečiti medikamentima, bar u početnoj fazi.…”