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White Coat Hypertension and Cardiovascular Diseases: Innocent or Guilty

  • Mehran Abolbashari
Ischemic Heart Disease (D Mukherjee, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Ischemic Heart Disease

Abstract

Purpose of Review

This review aims to clarify the cardiovascular risk of white coat hypertension (WCH).

Recent Findings

Cardiovascular risk of WCH has been evaluated in multiple meta-analyses and population-based studies. International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes study evaluated the cardiovascular risk in 653 patients with WCH and 5137 normotensive patients. The patients were age-matched and were followed for 10.6 years. The results revealed no increased cardiovascular risk except in older high-risk WCH patients. A recent meta-analysis evaluated the cardiovascular risk in WCH subjects without any antihypertensive treatment (23 cohorts, 20 445 individuals), WCH subjects with antihypertensive treatment (11 cohorts, 8656 individuals), and mixed population including both treated and untreated subjects (12 cohorts, 21 336 individuals). This study revealed increased cardiovascular risk in untreated and mixed population WCH subjects but not in treated WCH subjects.

Summary

WCH might have prognostic impact on cardiovascular outcomes; however, this is not true in all WCH subjects. Further studies should identify the subgroups of WCH that are at increased risk and evaluate the effect of therapeutic measures on cardiovascular outcomes.

Keywords

White coat hypertension Cardiovascular disease Cardiovascular mortality Ambulatory blood pressure monitoring 

Notes

Compliance with Ethical Standards

Conflict of Interest

Mehran Abolbashari declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Kleinert HD, Harshfield GA, Pickering TG, Devereux RB, Sullivan PA, Marion RM, et al. What is the value of home blood pressure measurement in patients with mild hypertension? Hypertension. 1984;6:574–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Pickering TG, James GD, Boddie C, Harshfield GA, Blank S, Laragh JH. How common is white coat hypertension? JAMA. 1988;259:225–8.CrossRefPubMedGoogle Scholar
  3. 3.
    O’Brien E, Parati G, Stergiou G, et al. European society of hypertension position paper on ambulatory blood pressure monitoring. J Hypertens. 2013;31:1731–68.CrossRefPubMedGoogle Scholar
  4. 4.
    Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Zampi I, Gattobigio R, et al. White coat hypertension and white coat effect similarities and differences. Am J Hypertens. 1995;8:790–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension. Eur Heart J. 2013;34:2159–219.CrossRefPubMedGoogle Scholar
  6. 6.
    Martínez MA, García-Puig J, Martín JC, Guallar-Castillón P, Aguirre de Cárcer A, Torre A, et al. Frequency and determinants of white coat hypertension in mild to moderate hypertension: a primary care-based study. Monitorización Ambulatoria de la Presión Arterial (MAPA)-Area 5 Working Group. Am J Hypertens. 1999;12:251–9.CrossRefPubMedGoogle Scholar
  7. 7.
    •• Franklin SS, Thijs L, Asayama K, et al. The cardiovascular risk of white-coat hypertension. J Am Coll Cardiol. 2016;68:2033–43. A large population-based cohort study that evaluated the cardiovascular risk of WCH. CrossRefPubMedGoogle Scholar
  8. 8.
    Dolan E, Stanton A, Atkins N, Den Hond E, Thijs L, McCormack P, et al. Determinants of white-coat hypertension. Blood Press Monit. 2004;9:307–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Mancia G, Bertinieri G, Grassi G, Parati G, Pomidossi G, Ferrari A, et al. Effects of blood-pressure measurement by the doctor on patient’s blood pressure and heart rate. Lancet. 1983;2:695–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Grassi G, Turri C, Vailati S, Dell’Oro R, Mancia G. Muscle and skin sympathetic nerve traffic during the “white-coat” effect. Circulation. 1999;100:222–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Grassi G, Seravalle G, Buzzi S, Magni L, Brambilla G, Quarti-Trevano F, et al. Muscle and skin sympathetic nerve traffic during physician and nurse blood pressure measurement. J Hypertens. 2013;31:1131–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Jhalani J, Goyal T, Clemow L, Schwartz JE, Pickering TG, Gerin W. Anxiety and outcome expectations predict the white-coat effect. Blood Press Monit. 2005;10:317–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Spruill TM, Pickering TG, Schwartz JE, Mostofsky E, Ogedegbe G, Clemow L, et al. The impact of perceived hypertension status on anxiety and the white coat effect. Ann Behav Med. 2007;34:1–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Siegel WC, Blumenthal JA, Divine GW. Physiological, psychological, and behavioral factors and white coat hypertension. Hypertension. 1990;16:140–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension. J Hypertens. 2013;31:1281–357.CrossRefPubMedGoogle Scholar
  16. 16.
    Verdecchia P, Palatini P, Schillaci G, Mormino P, Porcellati C, Pessina AC. Independent predictors of isolated clinic (‘white-coat’) hypertension. J Hypertens. 2001;19:1015–20.CrossRefPubMedGoogle Scholar
  17. 17.
    Manios ED, Koroboki EA, Tsivgoulis GK, Spengos KM, Spiliopoulou IK, Brodie FG, et al. Factors influencing white-coat effect. Am J Hypertens. 2008;21:153–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Fisher M, Blackwell J, Saseen J. Clinical inquiries. What is the best way to identify patients with white-coat hypertension? J Fam Pract. 2005;54(549–50):552.Google Scholar
  19. 19.
    Sega R, Cesana G, Milesi C, Grassi G, Zanchetti A, Mancia G. Ambulatory and home blood pressure normality in the elderly: data from the PAMELA population. Hypertension. 1997;30:1–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Agyemang C, Bhopal R. Is the blood pressure of people from African origin adults in the UK higher or lower than that in European origin white people? A review of cross-sectional data. J Hum Hypertens. 2003;17:523–34.CrossRefPubMedGoogle Scholar
  21. 21.
    Agyemang C, Bhopal R, Bruijnzeels M, Redekop WK. Does the white-coat effect in people of African and South Asian descent differ from that in White people of European origin? A systematic review and meta-analysis. Blood Press Monit. 2005;10:243–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Labinson PT, Giacco S, Gift H, Mansoor GA, White WB. The importance of the clinical observer in the development of a white-coat effect in African-American patients with hypertension. Blood Press Monit. 2008;13:139–42.CrossRefPubMedGoogle Scholar
  23. 23.
    Staessen JA, Asmar R, De Buyzere M, Imai Y, Parati G, Shimada K, et al. Task Force II: blood pressure measurement and cardiovascular outcome. Blood Press Monit. 2001;6:355–70.CrossRefPubMedGoogle Scholar
  24. 24.
    National Institute for Health and Clinical Excellence (NICE) (2011) The clinical management of primary hypertension in adults. UK: National Clinical Guideline CentreGoogle Scholar
  25. 25.
    Lovibond K, Jowett S, Barton P, et al. Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study. Lancet. 2011;378:1219–30.CrossRefPubMedGoogle Scholar
  26. 26.
    O’Brien E, Asmar R, Beilin L, et al. European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens. 2003;21:301–6.Google Scholar
  27. 27.
    Hermida RC, Ayala DE, Fernández JR, Mojón A. Sleep-time blood pressure: prognostic value and relevance as a therapeutic target for cardiovascular risk reduction. Chronobiol Int. 2013;30:68–86.CrossRefPubMedGoogle Scholar
  28. 28.
    Hermida RC, Ayala DE, Mojon A, Fernandez JR. Influence of time of day of blood pressure-lowering treatment on cardiovascular risk in hypertensive patients with type 2 diabetes. Diabetes Care. 2011;34:1270–6.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC practice guidelines for the management of arterial hypertension. Blood Press. 2014;23:3–16.CrossRefPubMedGoogle Scholar
  30. 30.
    James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults. JAMA. 2014;311:507.CrossRefPubMedGoogle Scholar
  31. 31.
    Fagard RH, Staessen JA, Thijs L, et al. Relationship between ambulatory blood pressure and follow-up clinic blood pressure in elderly patients with systolic hypertension. J Hypertens. 2004;22:81–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Ohkubo T, Kikuya M, Metoki H, Asayama K, Obara T, Hashimoto J, et al. Prognosis of “masked” hypertension and “white-coat” hypertension detected by 24-h ambulatory blood pressure monitoring 10-year follow-up from the Ohasama study. J Am Coll Cardiol. 2005;46:508–15.CrossRefPubMedGoogle Scholar
  33. 33.
    Fagard RH, Cornelissen VA. Incidence of cardiovascular events in white-coat, masked and sustained hypertension versus true normotension: a meta-analysis. J Hypertens. 2007;25:2193–8.CrossRefPubMedGoogle Scholar
  34. 34.
    • Briasoulis A, Androulakis E, Palla M, Papageorgiou N, Tousoulis D. White-coat hypertension and cardiovascular events. J Hypertens. 2016;34:593–9. Meta-analysis evaluating the cardiovascular risk in subjects with WCH. CrossRefPubMedGoogle Scholar
  35. 35.
    •• Huang Y, Huang W, Mai W, Cai X, An D, Liu Z, et al. White-coat hypertension is a risk factor for cardiovascular diseases and total mortality. J Hypertens. 2017;35:677–88. The largest meta-analysis evaluating the cardiovascular risk in WCH subjects. CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    • Sivén SSE, Niiranen TJ, Kantola IM, Jula AM. White-coat and masked hypertension as risk factors for progression to sustained hypertension. J Hypertens. 2016;34:54–60. A population-based study evaluating the progression of WCH to sustained HTN over 11 years. CrossRefPubMedGoogle Scholar
  37. 37.
    Mancia G, Bombelli M, Facchetti R, Madotto F, Quarti-Trevano F, Friz HP, et al. Long-term risk of sustained hypertension in white-coat or masked hypertension. Hypertension. 2009;54:226–32.CrossRefPubMedGoogle Scholar
  38. 38.
    de la Sierra A, Vinyoles E, Banegas JR, Segura J, Gorostidi M, de la Cruz JJ, Ruilope LM. Prevalence and clinical characteristics of white-coat hypertension based on different definition criteria in untreated and treated patients. J Hypertens. 2007;35:2388–2394.Google Scholar
  39. 39.
    Mancia G, Facchetti R, Bombelli M, Grassi G, Sega R. Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure. Hypertension. 2006;47:846–53.CrossRefPubMedGoogle Scholar
  40. 40.
    Mancia G, Facchetti R, Parati G, Zanchetti A. Effect of long-term antihypertensive treatment on white-coat hypertension. Hypertension. 2014;64:1388–98.CrossRefPubMedGoogle Scholar
  41. 41.
    Fagard RH, Staessen JA, Thijs L, et al. Response to antihypertensive therapy in older patients with sustained and nonsustained systolic hypertension. Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Circulation. 2000;102:1139–44.CrossRefPubMedGoogle Scholar
  42. 42.
    Mancia G, Bombelli M, Brambilla G, Facchetti R, Sega R, Toso E, et al. Long-term prognostic value of white coat hypertension: an insight from diagnostic use of both ambulatory and home blood pressure measurements. Hypertension. 2013;62:168–74.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Cardiovascular MedicineTexas Tech University Health Sciences Center El PasoEl PasoUSA

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