Abstract
Purpose
This study aimed to determine blood pressure characteristics and long-term progress in patients with white coat hypertension (WCH) and obstructive sleep apnea (OSA).
Methods
Systolic blood pressure (SBP) and diastolic blood pressure (DBP) and sleep test results over a period of 26 months were analyzed from WCH patients with OSA (n = 28), WCH patients (n = 23), and healthy control subjects (n = 27).
Results
At the end of observation, WCH patients with OSA presented significantly increased daytime and nighttime BP and lower diurnal difference of SBP (all Ps < 0.05) and the increased rate of “non-dipper” status (SBP 28.6 %, DBP 32.1 %) was significantly higher when compared with WCH and control groups (all Ps < 0.01). Sustained hypertension was observed in 42.8 % of the WCH patients with OSA, which was significantly higher than that in the WCH and control groups (Ps < 0.01) and was predicted by non-dipper status via 24-h ambulatory SBP/DBP monitoring (Ps < 0.05).
Conclusion
WCH may represent a prehypertension status, which could develop into sustained hypertension with OSA.
Similar content being viewed by others
References
Pickering TG, Coats A, Mallion JM, Mancia G, Verdecchia P (1999) Blood pressure monitoring. Task Force V: white-coat hypertension. Blood Press Monit 4:333–341
Pierdomenico SD, Lapenna D, Di Mascio R, Cuccurullo F (2008) Short and long-term risk of cardiovascular events in white-coat hypertension. J Hum Hypertens 22:408–414
Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Gattobigio R, Sacchi N, Guerrieri M, Comparato E, Porcellati C (1996) Identification of subjects with white-coat hypertension and persistently normal ambulatory blood pressure. Blood Press Monit 1:217–222
Mancia G, Bombelli M, Seravalle G, Grassi G (2011) Diagnosis and management of patients with white-coat and masked hypertension. Nat Rev Cardiol 8:686–693
Verdecchia P, Angeli F (2005) The natural history of white-coat hypertension in the long term. Blood Press Monit 10:65–66
Silverberg DS, Oksenberg A (2001) Are sleep-related breathing disorders important contributing factors to the production of essential hypertension? Curr Hypertens Rep 3:209–215
Informe V (1993) The fifth report of the Joint National Committee on detection, evaluation, and treatment of high blood pressure (JNC-V). Arch Intern Med 153:154–183
Pickering T, Kaplan N, Krakoff L (1996) American Society of Hypertension Expert Panel: conclusions and recommendations on the clinical use of home (self) and ambulatory blood pressure monitoring. Am J Hypertens 9:1–11
Rechtschaffen A, Kales A (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. National Institutes of Health, Washington, DC
Quan SF, Gillin JC, Littner MR, Shepard JW (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22:662–689
Ogedegbe G, Pickering TG, Clemow L, Chaplin W, Spruill TM, Albanese GM, Eguchi K, Burg M, Gerin W (2008) The misdiagnosis of hypertension: the role of patient anxiety. Arch Intern Med 168:2459
Tsai PS (2002) White coat hypertension: understanding the concept and examining the significance. J Clin Nurs 11:715–722
Mancia G, Zanchetti A (1996) White-coat hypertension: misnomers, misconceptions and misunderstandings. What should we do next? J. Hypertens 14:1049–1052
Mancia G (2000) White coat effect. Innocuous or adverse phenomenon? Eur. Heart J 21:1647–1648
Gustavsen PH, Høegholm A, Bang LE, Kristensen KS (2003) White coat hypertension is a cardiovascular risk factor: a 10-year follow-up study. J Hum Hypertens 17:811–817
Mancia G, Facchetti R, Bombelli M, Grassi G, Sega R (2006) Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure. Hypertension 47:846–853
Ugajin T, Hozawa A, Ohkubo T, Asayama K, Kikuya M, Obara T, Metoki H, Hoshi H, Hashimoto J, Totsune K, Satoh H, Tsuji I, Imai Y (2005) White-coat hypertension as a risk factor for the development of home hypertension: the Ohasama study. Arch Intern Med 165:1541–1546
García-Río F, Pino JM, Alonso A, Arias MA, Martínez I, Alvaro D, Villamor J (2004) White coat hypertension in patients with obstructive sleep apnea-hypopnea syndrome. Chest 125:817–822
Sulit L, Storfer-Isser A, Kirchner HL, Redline S (2006) Differences in polysomnography predictors for hypertension and impaired glucose tolerance. Sleep 29:777–783
Rajagopalan N (2011) Obstructive sleep apnea: not just a sleep disorder. J Postgrad Med 57:168–175
Hla KM, Young T, Finn L, Peppard PE, Szklo-Coxe M, Stubbs M (2008) Longitudinal association of sleep-disordered breathing and nondipping of nocturnal blood pressure in the Wisconsin Sleep Cohort Study. Sleep 31:795–800
Pankow W, Nabe B, Lies A, Becker H, Köhler U, Kohl FV, Lohmann FW (1997) Influence of sleep apnea on 24-hour blood pressure. Chest Journal 112:1253–1258
Loredo JS, Ancoli-Israel S, Joel E, Dimsdale (2001) Sleep quality and blood pressure dipping in obstructive sleep apnea. Am J Hypertens 14:887–892
Ancoli-Israel S, Stepnowsky C, Dimsdale J, Marler M, Cohen-Zion M, Johnson S (2002) The effect of race and sleep-disordered breathing on nocturnal BP “dipping” analysis in an older population. Chest Journal 122:1148–1155
Baguet JP, Barone-Rochette G, Pépin JL (2009) Hypertension and obstructive sleep apnoea syndrome: current perspectives. J Hum Hypertens 23:431–443
Conflict of interest
The authors declare no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
Li Li and Li-zhu Guo contributed equally to this work.
Rights and permissions
About this article
Cite this article
Li, L., Guo, Lz., Li, J. et al. White coat hypertension and obstructive sleep apnea. Sleep Breath 19, 1199–1203 (2015). https://doi.org/10.1007/s11325-015-1137-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11325-015-1137-7