Guidi E, Giglioni A, Cozzi MG, Minetti EE
Which urinary proteins are decreased after ACE
inhibition?
12th Annual ASH Meeting
Am J Hypertens
(Apr) 10:128A 1997
It has been suggested that office or "white coat" hypertension is
benign and does not require treatment. However, most of the
previous studies on this topic included patients who had already
received antihypertensive treatment.
76 untreated patients [20
with white coat hypertension (WCH) and 56 with sustained
hypertension (SH)] and 32 matched controls were studied. There
were no differences between the groups in echocardiographic left
ventricular mass (LVM 41.5 ± 11, 45.5 ± 10, 41.5 ± 10
g/m2 in
WCH, SH and controls, respectively) or carotid artery
intimal-medial thickness (IMT 0.54 ± 0.13, 0.59 ± 0.14, 0.55
±
0.16 mm). However, left ventricular diastolic function was
significantly decreased in both WCH and SH (E/A = 1.08 ± 0.3,
1.04 ± 0.3, 1.43 ± 0.3, p= 0.03) and carotid diameter
significantly lower than that expected by the pressure-diameter
relationship in normotensives.
These results suggest that white
coat hypertension may not be benign. The authors suggest
prospective clinical trials be undertaken to evaluate the benefit
of early treatment in such patients.
Comment: WCH is present in 20-25% of patients with mild office
hypertension (i.e., diastolic BPs 90-104 mmHg); however, it is
uncommon in patients with DBPs > 104 mmHg. Whether WCH is
associated with structural cardiovascular changes is
controversial. In contradistinction to these findings,
Cavillini
et al. (Hypertension 1995; 26:413)
found that cardiac and carotid
structure were normal in WCH. Guida et al. do not give a
definition of WCH in their study. One wonders if WCH was
associated with higher arterial pressures by ambulatory
monitoring. In any case, WCH cannot be dismissed, as
approximately 3/4 of patients with office hypertension but normal
mean ambulatory pressures will eventually evolve to sustained
hypertension
(Bidlingmeyer et al. J Hypertens 1996: 14:327).
(David J. Leehey, M.D., Loyola University at Chicago)
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12th Annual ASH Meeting
H: Pathophysiology :
Kidney in hypertension
H: Drug therapy :
ACE inhibitors