Clinical Implications of White Coat Hypertension

Pose‐Reino, Antonio; González-Juanatey, J R; C, Pastor; Méndez, Isabel García; Estévez, Juan C.; Álvarez, Diego; Valdés, Luis; Cabezas-Cerrato, J

doi:10.3109/08037059609078058

Cited by 27 publications

(16 citation statements)

References 32 publications

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“…As a result of the existing controversy on whether white-coat hypertension is a benign condition or a pathophysiological entity leading to similar complications with sustained hypertension, 15,16 white-coat hypertensives were excluded from this study, to avoid possible methodological errors. In order to identify correctly sustained hypertensives, all participants underwent 24 h ambulatory blood pressure monitoring (ABPM).…”

Section: Introductionmentioning

confidence: 99%

Increased prevalence of Chlamydophila pneumoniae but not Epstein–Barr antibodies in essential hypertensives

et al. 2003

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Conflicting data exist regarding the relationship between Chlamydophila pneunoniae (C. pneumoniae) and hypertension. In this study, both C. pneumoniae IgG and IgA titres and Epstein-Barr virus antibody levels were measured in 146 sustained hypertensives defined by 24 h ambulatory blood pressure monitoring (ABPM) and 54 normotensives. C. pneumoniae antibodies were measured by microimmunofluorescence test. IgGX80 and IgAX40 were defined as elevated antibody titres. Epstein-Barr antibodies were measured in order to investigate whether a possible association exists between hypertension and other, similarly widespread in the general population, intracellular microorganisms. All participants underwent casual blood pressure (BP) readings and 24 h ABPM. Subjects having mean 24 h systolic/diastolic ambulatory BP4125/80 mmHg, with or without antihypertensive medication were defined as hypertensives. Controls were free of any history or clinical evidence of hypertension, cardiovascular or pulmonary disease. Of the total participants, 77 hypertensives (52.7%) and 10 normotensives (18.5%) had IgA titres X40 (crosstabs Po0.000), whereas 76 hypertensives (52.1%) and 15 normotensives (27.8%) had IgG titres X80, (crosstabs Po0.002). No difference was found in Epstein-Barr antibodies, between hypertensives and normotensives. In conclusion, C. pneumoniae, but not Epstein-Barr, antibody levels were found significantly higher in sustained hypertensives, suggesting high frequency of chronic C. pneumoniae, infections in this specific group of patients.

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Section: Introductionmentioning

confidence: 99%

Increased prevalence of Chlamydophila pneumoniae but not Epstein–Barr antibodies in essential hypertensives

et al. 2003

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“…Many, but not all, of these studies have demonstrated increased LVMI in WCH subjects, with LVMI intermediate between that of subjects with normotension and those with sustained hypertension. [2][3][4][5][6][7][8][9][10][11][12][13] In addition, a recent study suggests that the long-term incidence of stroke may be elevated in adults with WCH. 14 Little is known about the clinical significance and natural history of WCH in children.…”

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confidence: 99%

Left Ventricular Mass Index in Children with White Coat Hypertension

Lande

Meagher

Fisher

et al. 2008

The Journal of Pediatrics

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Objective-To determine if children with white coat hypertension (WCH) have evidence of targetorgan damage by comparing left ventricular mass index (LVMI) of subjects with WCH to that of matched normotensive and hypertensive controls.Study design-Each WCH subject was matched by body mass index (± 10%), age (± 1 year), and sex to a normotensive control and to a hypertensive control. Echocardiograms were reviewed to determine LVMI for each subject. These triple matches were analyzed using repeated measures analysis of variance to detect differences in LVMI between the three groups.Results-Twenty-seven matched triplets were established. The groups were comparable for sex, age, and body mass index (BMI). Mean LVMI was 29.2, 32.3, and 35.1 g/m 2.7 , for normotensives, WCH, and sustained hypertensives, respectively (normotensive vs. WCH, p = 0.028; WCH vs. sustained hypertensive, p = 0.07). Left ventricular hypertrophy was not present in any subject in the normotensive or WCH groups, but was present in 26% of the sustained hypertensive subjects (p < 0.001).Conclusions-After controlling closely for BMI, children with WCH had a LVMI which was intermediate between that of normotensives and sustained hypertensives, suggesting that WCH may be associated with hypertensive end-organ effects.White coat hypertension (WCH) occurs when blood pressure is elevated in the medical office but is normal outside the office setting. In adults, there is concern that WCH may be an independent risk factor for cardiovascular disease or that it may represent a prehypertensive state, with increased risk of progression to sustained hypertension. 1 Numerous adult studies have evaluated left ventricular mass index (LVMI) in subjects with WCH. Many, but not all, Corresponding Author: Marc B. Lande, MD, 601 Elmwood Ave, Box 777, Rochester, NY 14642, Phone: 585-275-9784, Fax: 585-756-8054, Email: marc_lande@urmc.rochester.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. The objective of the current study was to determine if children with WCH have evidence of hypertensive target-organ effects by comparing LVMI in children with WCH, normotension, and sustained hypertension, closely matching subjects for BMI, sex, and age. NIH Public Access MethodsThe study was performed at the University of Rochester Medical Center in Rochester, NY. At this center, ABPM has been used in the evaluation of pediatric primary hypertension since October 2002. The clinical purpose of ABPM has been primarily to differentiate between sustained hypertension and white coat hypertension. It has been our practice to obtain ech...

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“…[15][16][17] Glen et al 18 have shown that there was reduced carotid arterial compliance and impaired left ventricular diastolic function, while Julius et al 14 have shown that patients with WCH had high prevalence of several metabolic disturbances. In the paper by Pose-Reino et al 26 it was reported that cardiac remodelling and retinopathy develop early in parallel to the development of hypertension in patients with WCH.…”

Section: Discussionmentioning

confidence: 99%

“…This incidence varies according to the methods used for the diagnosis of silent ischaemia. 26 Generally, it is accepted to be between 20 and 50%. [19][20][21][22] Ashmar 19 showed that during episodes of ST depression, systolic and diastolic blood pressures increase.…”

Section: Discussionmentioning

confidence: 99%

The prevalence of silent myocardial ischaemia in patients with white-coat hypertension

et al. 1998

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The aim of this study was to estimate the incidence of silent myocardial ischaemia in patients with mild to moderate hypertension, white-coat hypertension (WCH) and those with normal blood pressure. Ambulatory electrocardiographic (ECG) monitoring was carried out in 272 cases with normal blood pressure, 164 cases with mild to moderate hypertension (diastolic blood pressure Ͼ95 and Ͻ114 mm Hg), and 106 cases with white-coat hypertension who were diagnosed with ambulatory blood pressure monitoring. The ages of the patients of all groups were between 42-61 years. There were no differences between the groups according to age, gender

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Clinical Implications of White Coat Hypertension

Cited by 27 publications

References 32 publications

Increased prevalence of Chlamydophila pneumoniae but not Epstein–Barr antibodies in essential hypertensives

Increased prevalence of Chlamydophila pneumoniae but not Epstein–Barr antibodies in essential hypertensives

Left Ventricular Mass Index in Children with White Coat Hypertension

The prevalence of silent myocardial ischaemia in patients with white-coat hypertension

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