The Impact of White‐Coat Hypertension on Cardiac Mechanics

Tadić, Marijana; Cuspidi, Cesare; Ivanović, Branislava; Vukomanovic, Vladan; Djelić, Marina; Ćelić, Vera; Kocijancic, Vesna

doi:10.1111/jch.12826

Cited by 17 publications

(18 citation statements)

References 24 publications

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“…We showed that even prehypertension could deteriorate RV mechanics 10 and subsequently revealed that RV thickness and RV diastolic function in the WCH subjects were between the normal subjects and the hypertensive patients. 37 RV GLS in WCH was also lower than in the controls, but still significantly higher than in the hypertensive patients. Multilayer RV strain assessment showed that both endocardial and mid-myocardial longitudinal strains in the WCH individuals were worse than in the normotensive controls, but still better than in the persistently hypertensive patients.…”

Section: Rv Strain In White Coat and Masked Hypertensionmentioning

confidence: 58%

“…The impact of prehypertension, WCH and MH on RV remodeling has been recently studied and the main results are briefly summarized in Table . We showed that even prehypertension could deteriorate RV mechanics and subsequently revealed that RV thickness and RV diastolic function in the WCH subjects were between the normal subjects and the hypertensive patients . RV GLS in WCH was also lower than in the controls, but still significantly higher than in the hypertensive patients.…”

Section: Rv Strain In White Coat and Masked Hypertensionmentioning

confidence: 99%

“…In the large meta-analyses, our study group showed the influence of WCH and MH on LV hypertrophy and diastolic dysfunction. 35,36 The impact of prehypertension, WCH and MH on RV remodeling has been recently studied 10,37,38 and the main results are briefly summarized in Table 3. We showed that even prehypertension could deteriorate RV mechanics 10 and subsequently revealed that RV thickness and RV diastolic function in the WCH subjects were between the normal subjects and the hypertensive patients.…”

Section: Rv Strain In White Coat and Masked Hypertensionmentioning

confidence: 99%

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Right heart remodeling induced by arterial hypertension: Could strain assessment be helpful?

Tadić

Cuspidi

Bombelli

2018

J of Clinical Hypertension

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Left ventricular structural and functional changes in patients with arterial hypertension are well established. However, the influence of arterial hypertension on right ventricular (RV) remodeling is still being investigated. The introduction of strain analysis provided an insight into RV function and mechanics. Previous research has demonstrated the predictive value of RV longitudinal strain in patients with various cardiovascular conditions, such as pulmonary hypertension, heart failure, congenital heart diseases, and valvular disease. Nowadays, we are aware of the fact that conventional echocardiographic methods usually do not provide necessary information about RV dysfunction in patients with arterial hypertension, which is why the evaluation of new parameters that could detect RV subtle changes in hypertension is essential. The present review article is an overview of the main principles of RV deformation and a summary of the current knowledge and clinical significance of RV strain in patients with arterial hypertension.

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Section: Rv Strain In White Coat and Masked Hypertensionmentioning

confidence: 58%

Section: Rv Strain In White Coat and Masked Hypertensionmentioning

confidence: 99%

Section: Rv Strain In White Coat and Masked Hypertensionmentioning

confidence: 99%

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Right heart remodeling induced by arterial hypertension: Could strain assessment be helpful?

Tadić

Cuspidi

Bombelli

2018

J of Clinical Hypertension

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“…In the same study, compared to normotensive patients, MHT, WCHT and SHT were associated with increased risk for adverse clinical outcomes [14]. In other studies, Cuspidi et al [15] and Tadic et al [16] demonstrated the harmful effects of white coat on heart in patients with WCHT. In another meta-analysis performed by Briasoulis et al, WCHT was associated with higher rates of cardiovascular morbidity and mortality compared with normotensive patients, but not significantly different in all-cause mortality and stroke risk [17].…”

Section: Discussionmentioning

confidence: 90%

Clinical Correlates of Ambulatory Blood Pressure Phenotypes at a Tertiary Care Hospital in Turkey

Erdogmus¹,

Kutlay²,

Celebi³

et al. 2018

Kidney Blood Press Res

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Background/Aims: Hypertension and its complications are major public health issues worldwide due to their association with high cardiovascular morbidity and mortality. Despite significant progress in health, the prevalence of hypertension is increasing. Ambulatory blood pressure monitoring (ABPM) is becoming increasingly important for the management of hypertension. In this study, we aimed to investigate the clinical and laboratory correlates of ambulatory blood pressure (ABP) phenotypes at a tertiary care hospital in Turkey. Methods: The characteristics of 1053 patients were retrospectively obtained from the hospital database. Hypertension was defined as patients with office blood pressure (BP) ≥140/90 mmHg and/or previously diagnosed hypertension and/or the use of antihypertensive medication. According to the office BP and ABPM results patients were identified namely: (1) sustained normotensive (SNT) patients (both office BP and ABPM were normal), (2) sustained hypertensive (SHT) patients (both office BP and ABPM were high), (3) masked hypertensive (MHT) patients (office BP were normal, but ABPM were high), (4) white coat hypertensive (WCHT) patients (office BP were above limits, but ABPM were normal). Results: A total of 1053 patients were included to the study (female/male: 608/445 and mean age 55 ± 15 years). The mean age of patients with hypertension was significantly higher than without hypertension (p< 0.0001). Hypertension was more frequent in females (p=0.009). The rates of history of diabetes mellitus (DM), hyperlipidemia (HL), and chronic kidney disease (CKD) were higher in patients with hypertension (p< 0.0001). Among patients with hypertension (n=853, 81%), ABPM results showed that 388 (45%) of patients had SHT, 92 (11%) had MHT, and 144 (17%) had WCHT, whereas 229 (27%) had SNT. Patients with MHT were significantly older than patients with SNT (p=0.025). The prevalence of SHT was higher in men than in women, whereas the prevalence of WCHT was higher in women than in men (p< 0.0001). There was no significant difference between 4 groups with regard to body mass index (p=0.142), a history of DM (p=0.189) and smoking status (self-reported) (p=0.306). Patients with SHT had the highest prevalence of history of hypertension, HL and CKD (p< 0.0001). Among patients without hypertension, 26 (13%) of patients had MHT and none of those patients was on antihypertensive treatment. Conclusion: Potential usages of ABPM in Turkey may include screening of high risk individuals who have traditional cardiovascular risk factors. It also provides clinicians valuable information on abnormal ABP phenotypes. Future studies are needed to clarify the risk factors of different ABP phenotypes and to evaluate the role of ABPM on detection and control of hypertension.

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“…In the article “The Impact of White‐Coat Hypertension on Cardiac Mechanics,” Tadic and colleagues examine the effect of WCH and sustained arterial hypertension (SHT) on right ventricular (RV) and left ventricular (LV) remodeling. Multilayer longitudinal strain was determined by modified two‐dimensional strain speckle tracking for the left and right ventricle.…”

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confidence: 99%

White‐Coat Hypertension: A True Cardiovascular Risk?

Mani

2016

J of Clinical Hypertension

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2White-coat hypertension (WCH) is a condition in which blood pressure (BP) rises in the medical setting, apparently as a result of anxiety. It is a common phenomenon, with about one third of all patients presenting with elevated BP in outpatient clinics. It is generally assumed that WCH causes no more than a 15 mm Hg increase in systolic and/or a 7 mm Hg increase in diastolic BP in otherwise normotensive patients and returns to baseline values in subsequent visits to a medical provider. A typical patient is generally a nonsmoking, higher-aged woman.Currently, there are no reliable prognostic data available for WCH, as patients are often treated on the basis of elevated office BP and large prospective randomized trials are lacking.In the article "The Impact of White-Coat Hypertension on Cardiac Mechanics," Tadic and colleagues 1 examine the effect of WCH and sustained arterial hypertension (SHT) on right ventricular (RV) and left ventricular (LV) remodeling. Multilayer longitudinal strain was determined by modified two-dimensional strain speckle tracking for the left and right ventricle. Overall, the investigators reproduced previous findings on the effects of hypertension on LV and RV deformation. They also concluded that deformational changes start in RV subendocardium as they were lower in subendocardial but not myocardial and subepicardial layers of the right ventricle in patients with WCH compared with normotensives. Interestingly, these changes happened despite preserved RV structure. The study has several limitations, however. The major limitation is the small size of the study population. Furthermore, the differences between patients with WCH and controls for the strain parameters were not substantial.Nonetheless, these findings remain interesting because they: (1) provide insight into the sequences of events in cardiac pathology, and (2) may implicate the need for antihypertensive therapy in WCH, particularly if future studies show that these structural abnormalities of subendocardium can advance to myocardium and result in diastolic and potentially systolic dysfunction.Several other studies have shown an increased cardiovascular (CV) risk in WCH compared with normotensive patients.In a clinical study by the author, using echocardiographic measurement of strain, LV longitudinal and circumferential strains were significantly lower in patients with white-coat hypertension compared with normotensive controls. These values were lowest in patients with SHT. 2In a meta-analysis of 29,100 participants (13,538 normotensive patients, 4806 with WCH and 10,756 with SHT, mean age of 59 years) followed-up for a period of 8 years, patients with WCH were shown to have higher rates of CV morbidity and mortality. However, all-cause mortality and stroke rates were only significantly increased in patients with SHT but not those with WCH as compared with normotensive patients. CV events were also higher in patients with WCH in a US study population. In this multiethnic study of 3000 US citizens (almost half African American...

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The Impact of White‐Coat Hypertension on Cardiac Mechanics

Cited by 17 publications

References 24 publications

Right heart remodeling induced by arterial hypertension: Could strain assessment be helpful?

Right heart remodeling induced by arterial hypertension: Could strain assessment be helpful?

Clinical Correlates of Ambulatory Blood Pressure Phenotypes at a Tertiary Care Hospital in Turkey

White‐Coat Hypertension: A True Cardiovascular Risk?

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