Pulse pressure is more susceptible to the white coat effect than is systolic blood presureObservations from real-life ambulatory blood pressure monitoring

Ben‐Dov, Iddo Z.; Perk, Gila; Ben-Arie, Liora; Mekler, Judith; Bursztyn, Michael

doi:10.1016/j.amjhyper.2004.02.018

Cited by 12 publications

(5 citation statements)

References 14 publications

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“…This may be comparable to a study in elderly isolated hypertensive patients that found that non-dippers had a higher average pulse pressure of 73 mmHg compared to 64 mmHg in the dippers [ 53 ]. The higher pulse pressure among non-dippers could be associated with the higher white coat effect on pulse pressure [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

High prevalence of non-dipping patterns among Black Africans with uncontrolled hypertension: a secondary analysis of the CREOLE trial

Ingabire

Ojji

Rayner³

et al. 2021

BMC Cardiovasc Disord

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Background Dipping of blood pressure (BP) at night is a normal physiological phenomenon. However, a non-dipping pattern is associated with hypertension mediated organ damage, secondary forms of hypertension and poorer long-term outcome. Identifying a non-dipping pattern may be useful in assessing risk, aiding the decision to investigate for secondary causes, initiating treatment, assisting decisions on choice and timing of antihypertensive therapy, and intensifying salt restriction. Objectives To estimate the prevalence and factors associated with non-dipping pattern and determine the effect of 6 months of three antihypertensive regimens on the dipping pattern among Black African hypertensive patients. Methods This was a secondary analysis of the CREOLE Study which was a randomized, single blind, three-group trial conducted in 10 sites in 6 Sub-Saharan African countries. The participants were 721 Black African patients, aged between 30 and 79 years, with uncontrolled hypertension and a baseline 24-h ambulatory blood pressure monitoring (ABPM). Dipping was calculated from the average day and average night systolic blood pressure measures. Results The prevalence of non-dipping pattern was 78% (564 of 721). Factors that were independently associated with non-dipping were: serum sodium > 140 mmol/l (OR = 1.72, 95% CI 1.17–2.51, p-value 0.005), a higher office systolic BP (OR = 1.03, 95% CI 1.01–1.05, p-value 0.003) and a lower office diastolic BP (OR = 0.97, 95% CI 0.95–0.99, p-value 0.03). Treatment allocation did not change dipping status at 6 months (McNemar’s Chi2 0.71, p-value 0.40). Conclusion There was a high prevalence of non-dipping among Black Africans with uncontrolled hypertension. ABPM should be considered more routinely in Black Africans with uncontrolled hypertension, if resources permit, to help personalise therapy. Further research is needed to understand the mechanisms and causes of non-dipping pattern and if targeting night-time BP improves clinical outcomes. Trial registration ClinicalTrials.gov (NCT02742467).

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Section: Discussionmentioning

confidence: 99%

High prevalence of non-dipping patterns among Black Africans with uncontrolled hypertension: a secondary analysis of the CREOLE trial

Ingabire

Ojji

Rayner³

et al. 2021

BMC Cardiovasc Disord

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“…WCE was defined as the difference between the office BP and the daytime BP, and found that WCE was strongly correlated with PWV. A study from a group in 688 consecutive patients confirmed that WCE was associated with arterial stiffness, and was predisposed to be present in patients with hypertension, both treated and untreated 10 . Barochiner and colleagues 11 found that WCE, calculated as the difference between mean office BP and mean home BP, showed a significant correlation with PWV both for systolic and diastolic BP.…”

Section: Disccusionmentioning

confidence: 95%

“…The association between WCE and arterial stiffness has been rarely studied, and some reports have used different indicators of arterial stiffness. The association between WCE and arterial stiffness has been reported in some studies, 8–12 but not in others 13,14 . Additionally, none of these studies have been conducted in a mixed population.…”

Section: Introductionmentioning

confidence: 94%

“…A study from a group in 688 consecutive patients confirmed that WCE was associated with arterial stiffness, and was predisposed to be present in patients with hypertension, both treated and untreated. 10 Barochiner and colleagues 11 found that WCE, calculated as the difference between mean office BP and mean home BP, showed a significant correlation with PWV both for systolic and diastolic BP. Moreover, Maseko and colleagues 12 observed the "office-day SBP" was related to PWV independent of Conversely, some studies have failed to demonstrate a relationship between WCE and arterial stiffness.…”

Section: Disccusionmentioning

confidence: 99%

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Relations between white coat effect of blood pressure and arterial stiffness

Cao

Yue

Gao

et al. 2022

J of Clinical Hypertension

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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.

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“…Пульсовое АД, по данным I. Z. Ben-Dov и соавт., у пациентов с АГ было взаимосвязано с выраженностью ЭБХ [50]. В исследовании Ohasama было показано, что пульсовое АД является независим предиктором величины разницы между скрининговым и домашним измерениями АД [51].…”

Section: основные механизмы и факторы взаимосвязанные с эбхunclassified

White coat effect in patients with hypertension

Andreeva,

Gorbunov,

Antipushina

et al. 2023

Racionalʹnaâ farmakoterapiâ v kardiologii

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The article is devoted to various aspects of white coat effect (WCE) in patients with hypertension (HTN). WCE is due to the patient’s anxious response to office blood pressure (BP) measurement and is characterized by a BP increase. In patients with HTN, WCE is detected with a high frequency. Pronounced WCE in hypertensive patients is associated with worsening the HTN course and the prognosis of all-cause and cardiovascular mortality. In addition, BP increase in these patients during a doctor’s visit may lead to additional prescription of antihypertensive drugs, increasing costs and side effects. To identify WCE, a large number of methods are used, which can be divided into following groups: I – data from clinical and daytime ambulatory blood pressure measurement, II – clinical and home BP assessment, III – only ambulatory BP measurement, IV – clinical and laboratory BP data, and V – only clinical BP measurement. There are following WCE in patients with HTN: female sex, age, never smoking, as well as anxiety, introversion, etc. WCE is due to the patient’s anxiety state during office BP measurement and a conditioned reflex BP increase associated both with the physician presence and medical background. Severe WCE in some groups of patients with HTN may be associated with a worse prognosis compared with other hypertensive patients as follows: in individuals with a significant difference between clinical and ambulatory blood pressure levels or between the first and third BP office data, with a combination of resistant HTN and WCE, with WCE increasing from visit to visit, etc.

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Pulse pressure is more susceptible to the white coat effect than is systolic blood presureObservations from real-life ambulatory blood pressure monitoring

Cited by 12 publications

References 14 publications

High prevalence of non-dipping patterns among Black Africans with uncontrolled hypertension: a secondary analysis of the CREOLE trial

High prevalence of non-dipping patterns among Black Africans with uncontrolled hypertension: a secondary analysis of the CREOLE trial

Relations between white coat effect of blood pressure and arterial stiffness

White coat effect in patients with hypertension

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