REMAINING CARDIOVASCULAR RISK MARKERS IN PARTICIPANTS WITH WHITE-COAT HYPERTENSION DIAGNOSED BY HOME BLOOD PRESSURE RECORDINGS

Abstract

Objective: White coat hypertension (WCH) is defined as having hypertensive blood pressure in the office but normal ambulatory or home blood pressure (HBP) levels. The cardiovascular prognosis in WCH is controversial. Some studies have demonstrated it to be a benign condition while others have linked it to possible health complications. The objective for this study is to evaluate remaining cardiovascular risk markers in WCH patients by analyzing interactions of WCH with metabolic factors, calcium score, pulse wave velocity (PWV) and carotid plaques in a large, randomly selected population-based cohort. Design and method: BP was measured in both clinic and at home in 5057 middle-aged participants. HBP was measured morning and evening for 7 days except for the first day in which the morning was spent in the clinic. WCH was defined as having a systolic OBP > = 140 mmHg and/or diastolic BP > = 90 mmHg while HBP systolic BP < 135 and diastolic BP < 85 mmHg. In some calculations WCH was lowered to HBP < 125/ < 75 mmHg. Normotensive BP was defined as OBP < 140/ < 90 and HBP < 135/ < 85. Blood tests, computer tomography (CT) scanning of the abdomen, coronary arterial angiography, arterial PWV, cardio-thoracic imaging and ultrasonography of the carotid arteries was performed. In addition, all participants filled out extensive electronic lifestyle questionnaires and this information was also accounted for. Independent t-tests were used for all calculations and to compare normotensives (NT) and WCH with the two different cut-offs, against known risk factors. Results: All tests showed significant signs of more metabolic and cardiovascular damage for WCH patients compared to normotensives, even with the stricter WCH definition (see table 1 and 2). Calculations from questionnaire data showed that normotensive women scored lower on a scale designed to measure nervousness than women with WCH (p = 0.022) and men with WCH reported a higher alcohol consumption than men with normal BP (0.012) Conclusions: Available data suggests that excessive BP reactivity limited to the doctor's office with stricter than usual definitions pose as a cardiovascular risk marker and that these patients probably could benefit from dedicated treatment.