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CV Risk of White-Coat Hypertension

J Am Coll Cardiol; 2016 Nov; Franklin, Thijs, et al

Publish date:

White-coat hypertension (WCH) size is related to aging, not to cardiovascular risk, according to a recent study that performed age- and cohort-matching between 653 untreated individuals with WCH and 653 normotensive control individuals. Researchers found:

  • Systolic white-coat-effect (WCE) increased by 3.6 mm Hg per 10-year increase in age, and was similar in low- and high-risk individuals with or without prior CVD events.
  • Incidence of new CVD events was higher in 159 high-risk individuals with WCH vs 159 cohort- and age-matched high-risk normotensive individuals (aHR, 2.06) over a median 10.6-year follow-up.
  • There was no significant increase in risk for 494 participants with low-risk WCH and age-matched low-risk normotensive participants.
  • An association between WCH and incident CVD events was limited to older (≥60 years) high-risk WCH participants.

Citation:

Franklin SS, Thijs L, Asayama K, et al. The cardiovascular risk of white-coat hypertension. J Am Coll Cardiol. 2016;68(19):2033-2043. doi:10.1016/j.jacc.2016.08.035.

Commentary:

The prevalence of white-coat hypertension increases with age and previous studies have shown that cardiovascular (CV) outcomes of patients with white-coat hypertension are similar to that of normotensive individuals. This study suggests that WCH infers risk particularly in patients who are at elevated CV risk by virtue of other risk factors and who are older than age 60. In other groups, consistent with previous studies, WCH has essentially the same risk as normotensive individuals. For this reason, for patients with moderately elevated blood pressure and without target organ damage, the joint scientific statement from the American Heart Association and American Society of Hypertension recommends checking home blood pressure with a minimum of 12 readings taken over 7 days. According to AHA guidelines, home blood pressure readings should be performed twice a day, first thing in the morning and at night before going to sleep. Evening readings tend to be higher than morning readings. If the average is over 135/85, then a diagnosis of hypertension is confirmed and treatment can be started.1 —Neil Skolnik, MD

  1. Pickering TG, et al. Call to action on use and reimbursement for home blood pressure monitoring. A joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension. 2008;52:10-29.

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