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

Pierdomenico, Sante D.; Lapenna, Domenico; Mascio, Rocco Di; Cuccurullo, Franco

doi:10.1038/jhh.2008.6

Cited by 41 publications

(22 citation statements)

References 27 publications

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“…There was no significant difference in outcome between WCHT and NT patients (daytime BP < 135/85 mmHg based on ambulatory BP) [50] . Pierdomenico et al [51] compared the cardiac and cerebrovascular risks in SHT and WCHT individuals, which were reported to be RR = 4.16, 95%CI: 1.48-11.6, P = 0.007, and RR = 4.12, 95%CI: 1.62-10.5, P = 0.003, respectively. There was no significant difference between the NT and WCHT individuals in this study, which followed 1732 subjects (1333 SHT, 399 WCHT, and 305 NT) for 6 years.…”

Section: Prognosis and Stroke Risk In Patients With White-coat Hypertmentioning

confidence: 99%

Closer look at white-coat hypertension

Sipahioğlu

2014

WJM

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This review aims to clarify novel concepts regarding the clinical and laboratory aspects of white-coat hypertension (WCHT). Recent studies on the clinical and biological implications of WCHT were compared with existing knowledge. Studies were included if the WCHT patients were defined according to the 2013 European Society of Hypertension guidelines, i.e., an office blood pressure (BP) of ≥ 140/90 mmHg, a home BP of ≤ 135/85 mmHg, and a mean 24-h ambulatory BP of ≤ 130/80 mmHg. WCHT studies published since 2000 were selected, although a few studies performed before 2000 were used for comparative purposes. True WCHT was defined as normal ABPM and home BP readings, and partial WCHT was defined as an abnormality in one of these two readings. The reported prevalence of WCHT was 15%-45%. The incidence of WCHT tended to be higher in females and in non-smokers. Compared with normotensive (NT) patients, WCHT was associated with a higher left ventricular mass index, higher lipid levels, impaired fasting glucose, and decreased arterial compliance. The circadian rhythm in WCHT patients was more variable than in NT patient's, with a higher pulse pressure and non-dipping characteristics. Compared with sustained hypertension patients, WCHT patients have a better 10-year prognosis; compared with NT patients, WCHT patients have a similar stroke risk, but receive more frequent drug treatment. There are conflicting results regarding WCHT and markers of endothelial damage, oxidative stress and inflammation, and the data imply that WCHT patients may have a worse prognosis. Nitric oxide levels are lower, and oxidative stress parameters are higher in WCHT patients than in NT patients, whereas the antioxidant capacity is lower in WCHT patients than in NT patients. Clinicians should be aware of the risk factors associated with WCHT and patients should be closely monitored especially to identify target organ damage and metabolic syndrome. Key words: White-coat hypertension; Ambulatory blood pressure; Target organ damage; Glucose dysregulation Core tip: There is contradictory information regarding the clinical presentations and prognosis of white-coat hypertension (WCHT). This review aims to summarize recent research and compare it to existing knowledge about WCHT. Published studies on the prevalence of WCHT, the associated target organ damage and cardiovascular markers, and WCHT patient prognosis were reviewed. WCHT may be a marker of future obesity and metabolic syndrome, is related to glucose dysregulation and left ventricular hypertrophy and may progress to sustained hypertension. Clinicians should be aware of the risk factors associated with WCHT, and patients should be closely monitored, especially to identify target organ damage and metabolic syndrome.Sipahioglu NT, Sipahioglu F. Closer look at white-coat hypertension. World

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Section: Prognosis and Stroke Risk In Patients With White-coat Hypertmentioning

confidence: 99%

Closer look at white-coat hypertension

Sipahioğlu

2014

WJM

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“…Yapılan bir diğer çalışmada, 81 BÖH hastasının altı yıl süreyle izlemi sonucunda hastaların %74 (medyan 2,5 yıl)'ünde hipertansiyon geliştiği bildirilmiştir. 17 TEDAVİ BÖH hastaları, artmış kardiyovasküler risk, hipertansiyon ve uç organ hasarı gelişebilme olasılıkla-rından dolayı dikkatli izlenmelidir. Antihipertansif tedaviden önce hayat tarzı değişiklikleri muhakkak önerilmelidir.…”

Section: Prognozunclassified

White-Coat Hypertension: Review

Cengiz¹,

Yavuzer²

2016

Turkiye Klinikleri J Intern Med

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13Beyaz Önlük Hipertansiyonu Ö ÖZ ZE ET T Bu çalışmada, beyaz önlük hipertansiyonu (BÖH)'nun klinik ve laboratuvar yönlerini gün-cel bilgilerle açıklamak amaçlanmıştır. BÖH üzerine yapılan son klinik çalışmalar mevcut bilgilerimizle beraber irdelenmiştir. Avrupa Hipertansiyon Derneği tarafından 2013 yılında yayımlanan kılavuza göre; ofis tansiyon ölçümlerinin ≥140/90 mmHg, ev tansiyon ölçümlerinin ≤135/85 mmHg ve 24 saatlik ambulatuar kan basıncı ölçümlerinin ≤130/80 mmHg olması BÖH olarak tanımlan-maktadır. BÖH prevalansının %15-45 oranında olduğu, insidansının kadınlarda ve sigara içmeyen bireylerde daha yüksek olduğu bilinmektedir. BÖH hastalarında dislipidemi, bozulmuş açlık glukozu ve artmış sol ventrikül kitle indeksi normotansiflere göre daha fazla görülmektedir. Tüm klinisyenler, BÖH hastalarını özellikle uç organ hasarı ve metabolik sendrom gelişimleri açısından izlemeli ve BÖH'deki risk faktörleri açısından dikkatli olmalıdır.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Beyaz önlük hipertansiyon; hipertansiyon A AB BS S T TR RA AC CT T This review aims to clarify novel concepts regarding the clinical and laboratory aspects of white-coat hypertension (WCHT). Recent studies on the clinical and biological implications of WCHT were compared with existing knowledge. WCHT patients were defined according to the 2013 European Society of Hypertension guidelines; an office blood pressure of ≥ 140/90 mmHg, a home blood pressure of ≤ 135/85 mmHg, and a mean 24-h ambulatory blood pressure of ≤130/80 mmHg. The reported prevalence of WCHT was 15%-45% and the incidence of WCHT tended to be higher in females and in non-smokers. Compared with normotensive patients, WCHT was associated with a higher left ventricular mass index, higher lipid levels, impaired fasting glucose, and decreased arterial compliance. Clinicians should be aware of the risk factors associated with WCHT and patients should be closely monitored especially to identify target organ damage and metabolic syndrome.K Ke ey y W Wo or rd ds s: : White-coat hypertension; hypertension T Tu ur r k ki i y ye e K Kl li i n ni ik k l le e r ri i J J I In nt te er rn n M Me ed d 2 20 01 16 6; ;1 1( (1 1) ): :1 13 3--6 6

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“…In two large studies, the incidence of CV events was similar in WCHT subjects when compared to normotensive subjects 60,61 or sustained mild hypertension. 62 These data were also confirmed by a meta-analysis published in 2007.…”

Section: Clinical Consequencesmentioning

confidence: 99%

White-coat hypertension and masked hypertension: an update

2015

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The precise quantification of blood pressure (BP) is an essential step to reach the largest number of correct diagnosis of arterial hypertension (AH) and consequently to optimize the anti-hypertensive therapy. Since the invention of the first sphygmomanometer in 1896, Riva-Rocci observed the inaccuracy of that method for a correct BP determination: 1 the simple appearance of a doctor was accompanied by an immediate rise in BP in some patients. Years later Pickering called this phenomenon white coat hypertension (WCHT). 2 The introduction of fully-automated BP measurement during the 24 h (ambulatory blood pressure monitoring, ABPM) allowed to observe the entire circadian BP profile, highlighting how BP could be normal in physician office and elevated at home, especially during the nocturnal period. 3 This last observation was named masked hypertension (MHT). 4 WCHT is defined as office BP persistently ≥140 mmHg systolic, ≥90 mmHG diastolic, or both, whereas out-of-office BP is within normal (<130/80 mmHg for 24-h mean BP, or <135/85 mmHG for home BP). 5-7 Medical environment triggers this alarm reaction, 8 through the hyperactivation of sympathetic nervous system. 9 It peaked 2-4 min after the start of the visit and continued throughout the duration of the physician's visit. 10 For this reason, international guidelines recommended to record at least two ABPM to confirm the diagnosis of WCHT and to determine the possible development of sustained hypertension. 11 Further WCHT can be divided into true WCH, when both home BP values and ABPM values are normal, and partial WCHT, when only one of these out-of-office measurements is normal. 5 If WCHT can determinate an overdiagnosis of AH, on the other hand some subjects present normal office BP values in contrast to pathological 24-h BP profile on ABPM or altered home BP. This reverse white-coat effect or MHT 12,13 is related to a worse cardiovascular (CV) prognosis 14 and also to the development of a target organ damage (TOD) comparable to sustained hypertension patients 15 (Table 1). Both WCHT and MHT are examples of how the correct evaluation of BP profile is a difficult challenge and how their better knowledge can lead to a more precise diagnosis and consequently to a proper treatment of AH. EpidemiologyThe prevalence of WCHT and MHT is not completely clear. AS a confounding factor several studies showed different values for normal BP. Regarding White-coat hypertension and masked hypertension: an update ABSTRACTWhite coat hypertension and masked hypertension are two conditions with a controversial role in the beginning and the progression of the cardiovascular disease. We focused our attention on the definition, the epidemiology, the pathophysiology and the clinical consequences of these two conditions, with an attention also on the management. This review was based on the papers found on PubMed and MEDLINE up to August 2015. The search terms used were white coat hypertension, masked hypertension in combination with epidemiology, management and pathophysiology.

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

Cited by 41 publications

References 27 publications

Closer look at white-coat hypertension

Closer look at white-coat hypertension

White-Coat Hypertension: Review

White-coat hypertension and masked hypertension: an update

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