Target-Organ Damage in Stage I Hypertensive Subjects With White Coat and Sustained Hypertension

Abstract

Controversy remains on whether white coat hypertension is a benign clinical condition or carries an increased risk of target-organ damage. Nine hundred forty-two stage I hypertensive subjects enrolled in the HARVEST trial underwent 24-hour ambulatory blood pressure monitoring and urine collection for albumin measurement. Reliable echocardiographic data were obtained in 722 subjects. White coat hypertensive subjects were defined on the basis of three different partition values: mean daytime blood pressure <130/90 mm Hg, <135/85 mm Hg, or <140/90 mm Hg. Ninety-five normotensive subjects with similar age and sex distribution were studied as controls. With all threshold levels, left ventricular mass index and wall thicknesses were greater in the sustained hypertensive subjects than in the white coat hypertensive subjects, also when these differences were adjusted for blood pressure readings taken in the office. Relative wall thickness was similar in the two hypertensive groups. All echocardiographic dimensional data were greater in the white coat hypertensive subjects than in the normotensive subjects. Urinary albumin and the prevalence of microalbuminuria were also greater in the sustained hypertensive subjects than in the white coat hypertensive subjects. No significant differences in urinary albumin were found between the white coat hypertensive and the normotensive subjects. These results show that within a population of subjects with stage I hypertension, subjects with white coat hypertension have a smaller degree of hypertensive complications than those with sustained hypertension, irrespective of their blood pressure levels taken in the office. However, in comparison with normotensive subjects, white coat hypertensive subjects seem to be at greater risk. Cardiac involvement seems to precede glomerular damage in the early stage of hypertension.

Metabolic syndrome in subjects with white-coat hypertension: impact on left ventricular structure and function

“…29 Other potential biologic mediators of LV hypertrophy in subjects with MetS may be certain peptide hormones, such as angiotensin II and leptin, which are secreted by white adipose tissue. 20 Our findings also suggest that the clustering of features of MetS, frequently described in WCHs, may be at least in part responsible for the cardiac abnormalities, and probably for the increased cardiovascular risk displayed in some, but not all, series regarding subjects with WCH [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] . On the other hand, the greater values of both LV mass and LV chamber diameter that we observed in WCHs without MetS when compared to those of normotensive controls, seem to indicate that WCH per se, independently of MetS, may not be innocuous for the heart.…”

“…1,2 Obviously, the use of higher limits for ambulatory BP results in higher frequencies of WCH individuals with end-organ damage. However, in previous investigations, such as the HARVEST (Hypertension and Ambulatory Recording Venetia Study) 3 and the PAMELA (Pressioni Arteriose Monitorate e Loro Associazioni) 4 studies, even when lower cutoffs of ambulatory BP were used, an association between WCH and left ventricular hypertrophy was found.…”

“…1,2 Indeed, the studies that evaluated the effects of WCH on hypertensive target organ damage and on the occurrence of future cardiovascular events yielded conflicting results. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] It has long been recognized that hypertension tends to cluster with various anthropometric and metabolic abnormalities, including elevated triglycerides, reduced high-density lipoprotein (HDL) cholesterol, glucose intolerance, abdominal obesity and insulin resistance, which are the main features of the metabolic syndrome (MetS). MetS, which may precede the appearance of sustained hypertension, contributes to the development of hypertensive target organ damage and atherosclerotic diseases.…”

Left Ventricular Mass Index in Children with White Coat Hypertension

“…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.…”

White coat hypertension: a recognised syndrome with uncertain implications

“…[5][6][7][8][9][10] The lack of an agreed definition for WCH further adds to the confusion. Furthermore, interpretation of these studies has been made more difficult as many are not controlled for the level of ambulatory BP.…”