Abstract
IntroductionIdentifying White Coat Hypertension (WCH) may avoid inappropriate commitment of individuals to lifelong and costly blood pressure (BP) lowering medications’. We assessed the prevalence and determinants of WCH in urban clinical settings in Cameroon.MethodsParticipants were a consecutive sample of adults, who underwent ambulatory BP measurements (ABPM) for the diagnosis of hypertension and evaluation of treatmentin three referral cardiac clinics in the cities of Yaounde and Douala, between January 2006 and July 2011. WCH was defined as an office-based systolic (or diastolic) BP ≥ 140(90) mmHg together with an average day time ambulatory systolic (and diastolic) BP < 135(85) mmHg.ResultsOf the 500 participants included, 188 (37.6%) were women, 230 (46%) were nonsmokers and 53 (10.6%) had diabetes mellitus. The mean age was 51.6±10.2years. The ABPM readings were higher in men than in women (p<0.05).The prevalence of WCH was 26.4% overall, 39.3% in women and22.4% in men (p=0.01).In multivariable analysis, body mass index was the only significant determinant of WCH (Odds ratio= 1.15(95% confidence intervals: 1.00-1.43), p<0.05).ConclusionThe prevalence of WCH was high in our study population and was correlated only with BMI. Accurate measurement of BP and appropriate diagnosis of hypertension using ABPM in this setting may help limiting the consequences of over estimating hypertension severity on individuals, families and health systems.
Highlights
Hypertension has been established as the commonest single risk factor for the occurrence of major cardiovascular events and deaths
Day and night time ambulatory blood pressure readings were lower for females
In this cross sectional study of hypertensive groups of patients from Douala and Yaounde,Cameroon,we found a high prevalence of WCH.This high prevalence was largely influenced by adiposity.To our knowledge, this is the largest study of ambulatory BP measurement (ABPM) in a sub-Saharan African setting and the used methodology provides findings that are comparable to other studies onWCH
Summary
Hypertension has been established as the commonest single risk factor for the occurrence of major cardiovascular events and deaths. It is a growing public health problem worldwide with a rapidly increasing prevalence in developing countries such as those in subSaharan Africa. The number of people affected is increasing so rapidly that some published data suggest that the prevalence of hypertension in developing countries is already matching that in developed countries [1,2,3]. The use of ABPM allows the identification of individuals with white coat hypertension and may help avoiding inappropriate commitment of individuals to lifelong and costly BP lowering medications [8]
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