Abstract
To assess the impact of sex on office white-coat effect tail (OWCET), the waning of systolic blood pressure (SBP) after its waxing during office visit, on the incidence of long-term major fatal and non-fatal events in two Italian residential cohorts [from the Gubbio Study and the Italian Rural Areas of the Seven Countries Study (IRA)]. There were 3565 persons (92 with missing data, 44% men, 54 ± 11 years) included in the Gubbio and 1712 men (49 ± 5 years) in the IRA studies. OWCET was defined as a decrease of ≥10 mmHg in SBP between successive measurements with slight measurement differences between the two cohorts. Cardiovascular (CVD), coronary heart disease (CHD) and stroke (STR) incidences were considered. Over an approximately 20-year follow-up, women with OWCET had an increased risk of CVD [HR: 1.591 (95%CI: 1.204–2.103)], CHD [HR: 1.614 (95%CI: 1.037–2.512)] and STR [HR: 1.696 (95%CI: 1.123–2.563)] events independently of age, serum and HDL cholesterol, cigarettes, BMI and SBP in the Gubbio study. However, there was no increased risk of CVD, CHD or STR in men with OWCET neither in the Gubbio 20-year follow-up nor in the IRA 50-year follow-up. These results were not modified significantly by the correction of the regression dilutions bias between the first and the subsequent SBP measurements. Thus, in primary care, OWCET should be actively evaluated in women as it can improve stratification of long-term CVD, CHD and STR risks.
Highlights
Whereas an increase of 10 mmHg in systolic BP (SBP) can almost triple the relative risk for cardiovascular disease (CVD)[1,2,3], the potential presence of the white coat effect (WCE)[2,4] may interfere with these changes during office visits
We asked whether the regression dilution bias (RDB)[1] might interfere, sex-wise, with office white-coat effect tail (OWCET) and we looked at this to corroborate the results in women versus men
After adjustment for age, systolic blood pressure (SBP), total and high-density lipoprotein (HDL) cholesterol, cigarettes and body mass index (BMI), positive OWCET remained significantly associated with a higher risk of CVD, coronary heart disease (CHD), and STR in women, but not in men (Table 1)
Summary
Whereas an increase of 10 mmHg in systolic BP (SBP) can almost triple the relative risk for cardiovascular disease (CVD)[1,2,3], the potential presence of the white coat effect (WCE)[2,4] may interfere with these changes during office visits. We have previously described a proxy of WCE obtained during a family medicine visit[5] It corresponds to the waxing and waning of BP and is defined as a ≥ 10 mmHg difference between the measurement made at the beginning and that made at the end of the visit. We named it ‘office white coat effect tail’ (OWCET) and showed that OWCET as a dichotomous variable, in the context of the large Gubbio residential cohort study with long-term follow-up, may interact with the exact measurement of BP and with the treatment of high BP, independent of several traditional risk factors including SBP5. We asked whether the regression dilution bias (RDB)[1] might interfere, sex-wise, with OWCET and we looked at this to corroborate the results in women versus men
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