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White-coat hypertension unlikely predictor of CV events in most patients
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The effect of white-coat hypertension is not related to CVD risk, but is related to aging, researchers reported in the Journal of the American College of Cardiology.
Using data from an 11-cohort database, researchers compared daytime ambulatory BP with conventional BP in 653 untreated patients with white-coat hypertension, defined as high office BP but normal ambulatory BP, and 653 age- and cohort-matched controls with normal BP.
Each patient was assigned a 5-stage risk score, with low risk defined as two or fewer risk factors and high risk defined as three to five risk factors, diabetes and/or past CVD event.
When Stanley S. Franklin, MD, and colleagues conducted a stepwise linear regression model, they found the systolic white-coat effect rose by 3.8 mm Hg (95% CI, 3.1-4.6) per 10-year increase in age and did not differ between low-risk and high-risk participants and in those with prior CVD events or without.
Franklin, from the Heart Disease Prevention Program, division of cardiology, University of California, Irvine, and colleagues determined that during a median of 10.6 years of follow-up, new CVD events happened more often in 159 high-risk participants with white-coat hypertension compared with 159 age- and cohort-matched participants with normal BP but at high CV risk (adjusted HR = 2.06; 95% CI, 1.1-3.84).
However, there was no difference in risk for new CVD events between 494 low-risk participants with white-coat hypertension and 494 low-risk participants with normal BP, according to the researchers.
Aging a factor
When Franklin and colleagues conducted a subgroup analysis by age, they determined the association between white-coat hypertension and new CVD events was restricted to those aged 60 years or older at high CVD risk. Among those in that age group, white-coat hypertension was associated with incident CVD in those at high risk (adjusted HR = 2.19; 95% CI, 1.09-4.37) but not in those at low risk (adjusted HR = 0.88; 95% CI, 0.51-1.53; P for interaction = .044).
More assessment needed
In a related editorial, Giuseppe Mancia, MD, and Guido Grassi, MD, both from University of Milano Bicocca in Milan, wrote that, “The extremely small number of events did not allow proper analysis of the CV risk in the younger population strata. We are also not sure that elderly subjects with a high CV risk are so few. An advanced age can lead to a high CV risk condition almost ‘per se.’”
They concluded that, “A more in-depth assessment of the factors involved in the determination of conventional ambulatory BP differences, not only may lead to more evidence-based definition of the white-coat effect, but also, beyond semantics, may provide a better understanding of the perhaps complex nature of [white-coat hypertension], and thus more properly deal with this condition from a medical standpoint.” – by Erik Swain
Disclosure: The researchers, Grassi and Mancia report no relevant financial disclosures.
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