White-coat hypertension versus sustained hypertension in Japan.

Abstract

To the Editor: Khattar and associates recently described the extent of target organ damage and the cardiovascular prognosis of white-coat hypertension in a middle-aged adult population.1 Pickering, who introduced the concept of “white coat hypertension” in clinical practice, provided editorial comments.2 The major conclusion of the study was that white-coat hypertension is relatively benign in hypertensive adult patients. There is some debate on the extent of target organ damage in white-coat hypertension. Some reports have concluded that target organ damage is advanced in white-coat hypertension compared with normotension, but others have not found any differences. There are important difference in the demographics of hypertensive target organ damage. In Japan, coronary artery disease is much less common and cerebrovascular disease more common than in Western countries. In our cross-sectional study using ambulatory blood pressure (BP) monitoring, silent lacunar infarction, a strong predictor of clinically overt stroke, was detected by brain MRI in 26% of elderly subjects with white-coat hypertension (mean [95% CI] age 72 [69–74] years; 34% male), whereas it was found in 52% of subjects with sustained hypertension.3 Thus, we believe that the benefits of antihypertensive treatment in Japanese to prevent stroke would be low in white-coat hypertension. We appreciate the comment of …