Effect of Long-Term Antihypertensive Treatment on White-Coat Hypertension

Abstract

A large number of studies has provided information on the clinical characteristics of subjects with isolated office or white-coat hypertension (WCH). [1][2][3][4][5][6][7][8][9][10][11][12][13] However, information is limited on whether and to what extent WCH is affected by antihypertensive treatment. The limitation includes the effect of treatment on blood pressure (BP) because although some studies have reported that in WCH treatment lowers office BP, 14 other studies deny that this occurs, quoting as an example the case of spurious resistant hypertension, that is, a condition in which a normal ambulatory BP (ABP) is accompanied by an office BP that remains elevated despite multiple drug treatment. 15,16 Furthermore, the effect of treatment on ABP values of WCH individuals is by no means clear because the reports range from a marked ABP fall to an ABP fall with some drugs only to no ABP fall at all. 14,[17][18][19][20][21][22][23][24][25][26][27] Previous studies on the BP effects of antihypertensive treatment in WCH have usually assessed ABP by just one 24-hour recording, sometimes without a baseline reference value.14,28 Primary aim of the present study has been to address the issue in a more adequate fashion by taking advantage of the unique data provided by the European Lacidipine Study on Atherosclerosis (ELSA) trial, 29 the only prospective antihypertensive treatment trial in which all patients with moderate elevations of both systolic BP (SBP) and diastolic BP (DBP) had office and ABP measured (1) before randomization to treatment and (2) at 6-month (office BP) and 12-month (ABP) intervals during treatment over a follow-up of 4 years. The multiple office and ABP measurements during the treatment period allowed us to more properly address also other issues relevant to WCH, such as the modification with time of the difference between office and ABP, often defined as the WC effect, 14,30 and the effect of treatment on within 24 hours and visit-to-visit BP variability (short-and long-term variability) of WCH vis-à-vis sustained hypertensive individuals. 31 These issues have never been addressed before. Methods Study Design and PatientsThe design and methods of the ELSA trial have been described in detail elsewhere. 29 Briefly, ELSA was a prospective, randomized, double-blind trial comparing the effects of long-term β-blocker or calcium antagonist treatment on the progression of carotid intimamedia thickness in mild-to-moderate essential hypertension. Randomization criteria were (1) an age between 45 and 75 years, Abstract-Limited evidence is available on the extent and frequency by which antihypertensive treatment lowers office blood pressure (BP) in white-coat hypertension (WCH). Data are even more scanty and discrepant on the corresponding effect on ambulatory BP (ABP). In the hypertensive patients of the European Lacidipine Study on Atherosclerosis (ELSA), office and ABP were measured before treatment and at 6-month (office BP) or 12-month (ABP) intervals during the 4-year administration of calcium chann...

The OXIMAPA Study: Hypertension Control by ABPM and Association with Sleep Apnea Syndrome by Pulse Oximetry

“…5 Regarding this fact, although some researchers suggest an association with higher CVR, the controversy on the benefit of treating such patients remains. 37 In our study, the prevalence of non-dipper profile (40%) was similar to the ones reported in other surveys (between 25% to 60%). 6,7 The occurrence of masked HBP (28% in our study) was relatively high, revealing the cases that are Considering nocturnal HBP as an important marker of CVR, 9,10 a significant prevalence (52%) was found in our study.…”

Health-related quality of life and blood pressure 12 months after renal denervation

“…Consistent with an earlier report by Mahfoud et al [21], in patients with uncontrolled hypertension due to a white-coat effect, office BP was reduced but there was no effect of RDN on ambulatory BP. This pattern of treatment response in patients with-white coat hypertension is strikingly similar to that observed with longterm pharmacological interventions [40]. Whereas these observations suggest that the renal sympathetic nerves are not the prime driver in the generation of hypertension in these patients, other sympathetic neural outflows could be involved and may lead to a degree of end-organ dysfunction.…”

White-coat hypertension is a risk factor for cardiovascular diseases and total mortality

“…However, whether patients with WCH would be benefited from antihypertensive treatment remains unknown. It has been shown that antihypertensive treatment might lower clinic BP, rather than ABP [40,43]. A post-hoc analysis of a subgroup of patients from the Systolic Hypertension in Europe trial also showed that in WCH, antihypertensive treatment did not lower cardiovascular events [44].…”