The aim of this study was to analyze the relationship between brachial-ankle pulse wave velocity (b-a PWV) and white coat effect (WCE), that is the difference between the elevated office blood pressure (BP) and the lower mean daytime pressure of ambulatory BP, in a mixed population of normotention, untreated sustained hypertension, sustained controlled hypertension, sustained uncontrolled hypertension, white coat hypertension, white coat uncontrolled hypertension. A total of 444 patients with WCE for systolic BP (54.1% female, age 61.86 ± 13.3 years) were enrolled in the study.Patients were separated into low WCE (<9.5 mm Hg) and high WCE (≥9.5 mm Hg) according to the median of WCE. The subjects with a high WCE showed a greater degree of arterial stiffness than those with a low WCE for systolic BP values (P < .05).The b-a PWV were 17.2 ± 3.3 m/s and 18.4 ± 3.4 m/s in low WCE and high WCE, respectively. The b-a PWV increased with the increase of WCE, showing a positive correlation between them (P > .05 for non-linearity). The significant association between the high WCE and the b-a PWV was confirmed by the results of multiple regression analysis after adjusting for confounding factors (β = .78, 95% Cl .25-1.31, P = . 004). Similar results were observed in subgroups. In conclusion, WCE is significantly associated with arterial stiffness. More research is needed to determine the WCE and target organ damage.

Ambulatory arterial stiffness index (AASI), a surrogate marker of arterial stiffness derived from ambulatory blood pressure (BP), which is calculated as 1 minus the linear slope of diastolic BP on systolic BP. Our study aim was to investigate the association between AASI and BP variation parameters, evaluated by both circadian rhythms and 24h coefficient of variation (CoV) in a population of normotension, untreated hypertension, controlled hypertension, uncontrolled hypertension, white coat hypertension and white coat uncontrolled hypertension. 610 subjects (48.7% female, age 60.9 ± 13.2 years), who underwent 24h ambulatory blood pressure monitoring were included; AASI was significantly higher in reverse-dipping than other dipping patterns, both in systolic and diastolic BP (p< .05). In a multiple linear regression analysis, circadian rhythms and 24h CoV in diastolic BP were independently associated with AASI after adjusted for multiple confounders (β=-0.002, 95% Cl -0.004~-0.001, P= .0004; β=-0.56, 95% Cl -0.78~-0.33, P< .001); the association between circadian rhythms and AASI were consistent across subgroups defined according to age, sex, BP phenotypes, smoking status, and white coat effect (p for interaction all>0.05). In conclusion, in subjects of different BP phenotypes, AASI was significantly associated with circadian rhythms and 24h CoV.