Task Force V: White-coat hypertension

Tg, Pickering; Coats, A.J.S.; Jm, Mallion; Mancia, Giuseppe; Verdecchia, Paolo

doi:10.1097/00126097-199912000-00006

Cited by 110 publications

(112 citation statements)

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“…Labelling a subject as a WCHs implies the arbitrary identification of cutoffs of ambulatory BP, which differed markedly from author to author, ranging from 80 to 95 mm Hg for diastolic BP and from 130 to 140 mm Hg for systolic BP. 1,2 Obviously, the use of higher limits for ambulatory BP results in higher frequencies of WCH individuals with end-organ damage. However, in previous investigations, such as the HARVEST (Hypertension and Ambulatory Recording Venetia Study) 3 and the PAMELA (Pressioni Arteriose Monitorate e Loro Associazioni) 4 studies, even when lower cutoffs of ambulatory BP were used, an association between WCH and left ventricular hypertrophy was found.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…1 The prognostic significance of WCH has been widely explored in the last years, but it is still a matter of debate. 1,2 Indeed, the studies that evaluated the effects of WCH on hypertensive target organ damage and on the occurrence of future cardiovascular events yielded conflicting results. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] It has long been recognized that hypertension tends to cluster with various anthropometric and metabolic abnormalities, including elevated triglycerides, reduced high-density lipoprotein (HDL) cholesterol, glucose intolerance, abdominal obesity and insulin resistance, which are the main features of the metabolic syndrome (MetS).…”

Section: Introductionmentioning

confidence: 99%

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Metabolic syndrome in subjects with white-coat hypertension: impact on left ventricular structure and function

et al. 2007

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Some reports have suggested that white-coat hypertension (WCH) is associated with some features of the metabolic syndrome (MetS). These metabolic disturbances, instead of WCH per se, may potentially explain the greater extent of end-organ damage sometimes observed in WCH subjects (WCHs) when compared to normotensive individuals (NTs). The aim of the present cross-sectional study was to compare left ventricular (LV) structure and function in three groups of subjects: WCHs with MetS, WCHs without MetS and NTs. A total of 145 WCHs, 35% of whom had MetS, were enrolled. As controls, 35 NTs were also studied. In all subjects, routine blood chemistry, echocardiographic examination and 24-h ambulatory blood pressure monitoring were performed. When compared with WCHs without MetS, those with MetS showed higher LV mass indexed by height elevated by a power of 2.7 (LVMH 2.7 ) (49.6714.8 vs 38.979.8 g/m 2.7 ; Po0.0001). The same parameter was greater in WCHs without MetS than in NTs (3278 g/m 2.7 ; P ¼ 0.004). Moreover, the E-wave deceleration time was longer in WCHs with MetS than in those without it (236.2766.4 vs 200.5730.8 ms; Po0.0001). The relationship of MetS with LVMH 2.7 was confirmed in multivariate regression models. Our results seem to suggest that MetS may have a deleterious influence on LV structure and function in WCH. However, WCH, being associated with an increased LV mass, also in subjects without MetS, may not be considered as an innocuous phenomenon.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Metabolic syndrome in subjects with white-coat hypertension: impact on left ventricular structure and function

et al. 2007

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“…For a significant number of patients, particularly those with high normal BPs or what JNC-7 termed prehypertension, 1 this WCE can result in diagnosing persons with essential hypertension when their daily life BPs are within normal limits. These misdiagnosed patients are typically referred to as having white coat hypertension, a common clinical problem, with prevalence estimates approximating 20% [2][3][4] of adult patients identified in primary medical care settings as having high BPs. Although there have been reports of increased target organ pathology among patients with white coat hypertension, 5 white coat hypertension is typically associated with lesser risk of cardiovascular target organ pathology than sustained hypertension.…”

Section: Introductionmentioning

confidence: 99%

“…Although there have been reports of increased target organ pathology among patients with white coat hypertension, 5 white coat hypertension is typically associated with lesser risk of cardiovascular target organ pathology than sustained hypertension. 4 Conversely, a second group of patients for whom clinic BP determinations correspond poorly with daily measures are typified by clinic measures that significantly underestimate average BP levels occurring during daily life. This phenomenon is termed the reverse WCE (RWCE).…”

Section: Introductionmentioning

confidence: 99%

Detecting white coat and reverse white coat effects in clinic settings using measures of blood pressure habituation in the clinic and patient self-monitoring of blood pressure

et al. 2007

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To examine the utility of blood pressure (BP) habituation within and across multiple clinic visits and patientdetermined home BP monitoring for detecting white coat (WCE) and reverse white coat effects (RWCE) commonly observed in medical settings, 54 patients undergoing evaluation for hypertension in an internal medicine group practice were categorized according to the magnitude of differences between systolic BP (SBP) and diastolic BP (DBP) obtained in the clinic and through ambulatory BP monitoring. BPs were measured four times during three separate clinic visits, during a 1-week home BP monitoring period, and during a single 24-h ambulatory monitoring period. Patients whose mean clinic and average daytime BPs were within 75 mm Hg were categorized as having stable BP; patients whose clinic BPs were 45 mm Hg of their daytime BPs were categorized as showing a WCE and patients whose average daytime BPs were 45 mm Hg of their clinic BPs were categorized as showing a RWCE. Results revealed that degree of habituation occurring between the first and third clinic visits significantly predicted magnitude of both the WCE and RWCE for SBP, with greater habituation being associated with the WCE and lesser habituation associated with the RWCE. Greater SBP habituation within clinic visits was associated with the WCE for SBP and greater DBP habituation within clinic visits was associated with the WCE for DBP. Lesser DBP habituation within clinic visits was associated with the RWCE for both SBP and DBP. Home BP monitoring did not contribute to predicting either WCE or RWCE.

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