Follow-Up Ambulatory Blood Pressure in Normotensives and Treated and Untreated White-Coat Hypertensive Subjects (Evaluation After 6.2 Years)

Polónia, Jorge; Gama, Glicia Gleide Gonçalves; Bertoquini, Susana; Amaral, Cristina

doi:10.1097/00004872-200406002-01045

Cited by 9 publications

(14 citation statements)

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“…23 In a study, a comparable proportion of subjects with clinical normotension and WCH evolved toward ambulatory hypertension (15% and 22%, respectively). 24 In this study, based on 38 100 person years of observation, the highest stroke rate was noted in the clinical-based JMS-ABPM cohort, which included elderly Japanese subjects with hypertension, followed by the Ohasama cohort, which included a general Japanese population, and the PIUMA cohort, which included Italian subjects with essential hypertension. The lowest stroke rate was observed in the NYPEAP cohort, recruited in the New York area.…”

Section: Clinical Relevance and Prognostic Value Of Wchmentioning

confidence: 79%

Short- and Long-Term Incidence of Stroke in White-Coat Hypertension

et al. 2005

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Abstract-White-coat hypertension (WCH) has been associated with a low risk for stroke, but long-term data are scanty. We analyzed individual data from 4 prospective cohort studies from the United States, Italy, and Japan that used comparable methodology for 24-hour noninvasive ambulatory blood pressure monitoring (ABPM). Overall, 4406 subjects with essential hypertension and 1549 healthy normotensive controls who were untreated at the time of initial ABPM were followed for a median of 5.4 years up to censoring or occurrence of a first stroke. At entry, mean age of subjects was 56 years (range 18 to 97). Prevalence of WCH was 9%. During follow-up, there were 213 new cases of stroke. Stroke rate (ϫ100 person years) was 0.35 in the normotensive group, 0.59 in the WCH group, and 0.65 in the group with ambulatory hypertension. In a multivariate analysis, the adjusted hazard ratio for stroke was 1.15 (95% confidence interval [CI], 0.61 to 2.16) in the WCH group (Pϭ0.66) and 2.01 (95% CI, 1.31 to 3.08) in the ambulatory hypertension group (Pϭ0.001) compared with the normotensive group. After the sixth year of follow-up, the incidence of stroke tended to increase in the WCH group, and the corresponding hazard curve crossed that of the ambulatory hypertension group by the ninth year of follow-up. In conclusion, WCH was not associated with a definitely increased risk of stroke during the total follow-up period. However, WCH might not be a benign condition for stroke in the long term.

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Section: Clinical Relevance and Prognostic Value Of Wchmentioning

confidence: 79%

Short- and Long-Term Incidence of Stroke in White-Coat Hypertension

et al. 2005

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“…It has been reported that part of them could develop SH during time. 24,25 Thus, it could be interesting to know whether events occurred in subjects with persistent WCH or in those who developed SH. Moreover, unlike the abovementioned study, 14 diabetic subjects were not included in our report.…”

Section: Discussionmentioning

confidence: 99%

Short- and long-term risk of cardiovascular events in white-coat hypertension

et al. 2008

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The prognostic impact of white-coat hypertension is not yet completely clear. In this study, we investigated cardiovascular outcome in sustained hypertension, white-coat hypertension and normotension in the short and long term. The occurrence of fatal and nonfatal cardiovascular events was evaluated in 1732 subjects with clinical hypertension (1333 with sustained and 399 with white-coat hypertension) and 305 with normotension. White-coat hypertension was defined as clinical hypertension and daytime blood pressure o135/85 mm Hg. During the period of observation (mean 6.4 years, range 0.7-13.1), 152 cardiovascular events occurred. The event rate per 100 patient-years in subjects with normotension, white-coat and sustained hypertension was 0.38, 0.44 and 1.58, respectively. Event-free survival was significantly different among the groups (Po0.0001). After adjustment for several covariates, Cox regression analysis showed that cardiovascular risk was significantly higher in patients with sustained than in those with white-coat hypertension (relative risk (RR) 3.32, 95% confidence interval (CI) 1.81-6.12, P ¼ 0.0001), whereas there was no significant difference between normotension and white-coat hypertension. When events were analysed separately, cardiac and cerebrovascular risk were significantly higher in sustained than in whitecoat hypertension (RR 4.16, 95% CI 1.48-11.6, P ¼ 0.007, and RR 4.12, 95% CI 1.62-10.5, P ¼ 0.003, respectively) and not significantly different between white-coat hypertension and normotension. Event-free survival had the same trend for the whole period of observation both when cardiovascular events were examined together and when cardiac and cerebrovascular events were analysed separately. In this study, cardiovascular risk in white-coat hypertension was significantly lower than that in sustained hypertension and not significantly different from normotension both in the short and long term.

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“…In contrast, others have documented a greater prevalence of structural and functional organ damage [11][12][13][14][15][16][17] and more albuminuria [18] in WCH as compared with matched normotensive controls. A non-negligible tendency for further development of sustained hypertension by subjects with WCH was reported by some [19] but not by others [20][21][22]. Prognosis of WCH has also been subject to controversy.…”

Section: Introductionmentioning

confidence: 95%