Verdecchia P, Schillaci G, Borgioni C, Ciucci A, et al.
Spontaneous evolution of white coat hypertension
11th Scientific Meeting, American Society of Hypertension
Am J Hypert
(Apr) 9:28A 1996
Several unanswered questions remain about patients with white-coat
hypertension (elevated office BP but normal ambulatory BP). Some of
these questions include 1) are these subjects with white-coat
hypertension at increased cardiovascular risk? 2) should these
patients be treated pharmacologically for their elevated office BP?
and 3) does the disparity in office and ambulatory BP persists over
time?
Verdecchia and colleagues attempt to answer the last
question by studying the natural history of white-coat hypertension.
They followed 64 patients with white coat hypertension (office BP 3
140/90 mmHg, daytime ambulatory BP < 131/86 mmHg for women and <136/87
mmHg for men) for 2.6 years. All subjects also had echocardiography
at the start and end of the study. The authors found that seventy-two
per cent of subjects remained in the white-coat hypertension group.
Clinic and daytime ambulatory BP averages, LV mass and peak A/E ratios
did not change in this group over time. In the 28% of subjects who
became hypertensive, office BP did not change but ambulatory BP and
LV mass significantly increased over the study period. Subjects who
remained in the white-coat hypertension group tended to be older and
more likely female.
Comment: While this study is interesting, the lack of
a control group makes it difficult to interpret the results. What
proportion of normotensives of similar age and living in the same
environment would become hypertensive, if followed for a similar
period of time? It is reassuring however, that the majority of
subjects did not evolve into the hypertensive group since treatment of
white-coat hypertensives pharmacologically is frequently met with poor
response in measured office BP and side effects. George Mansoor,
M.D., University of Connecticut
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11th Scientific Meeting, American Society of Hypertension
H: Exam and lab tests :
White coat hypertension