ObjectiveInternational guidelines advocate conservative management of post-stroke white coat hypertension. The aims of this study were to investigate; i) does WCH/E result in increased stroke risk? and ii) is WCH/E associated with surrogate markers of cardiovascular risk?MethodsThe Arterial Stiffness In Lacunar Stroke and TIA (ASIST) study recruited 96 patients, aged over 40 years old, with a confirmed diagnosis of transient ischaemic attack (TIA) or lacunar stroke in the preceding 14 days. Patients were grouped by BP phenotypes. Thirty-four patients were excluded (n = 6 declined ABPM, n = 3 masked hypertension, n = 25 sustained hypertension). Thirty-two patients with normal BP (clinic BP <140/90 mmHg and day-time ABPM <135/85 mmHg), and 30 patients with WCH/E (clinic BP >140/90 mmHg and day-time ABPM <135/85 mmHg) were recruited. Other surrogate markers measured were; Central aortic BP (SphygoCor, AtCor Medical), QKD100−60 interval and nocturnal dipping status (Diasys Integra II, Novocor).ResultsCompared to the normotensive cohort, patients with WCH/E were older, had a higher body mass index (BMI) and a larger proportion of patients were on anti-hypertensive medication. Both central systolic (145 ± 13 vs 118 ± 8, p < 0.001) and diastolic BP (82 ± 8 vs 76 ± 7, p = 0.004) were higher in WCH/E. The WCH/E cohort also had more lacunar strokes (p = 0.039) (Table 1).ConclusionIn this population of post-stroke patients, WCH/E was associated with higher prevalence of lacunar stroke. These individuals also had higher central pressures despite more patients being on anti-hypertensive treatment, suggesting that post-stroke WCH/E should be managed more aggressively.Table 1Normotension (N = 32)WCH/E (N = 30)SignificanceMale, n (%)21 (66)22 (73)0.511Age (years)69.9 ± 11.575.7 ± 9 30.033BMI (kg/m2)25 ± 428 ± 40.014Anti-hypertensive use, n (%)19 (59)23 (77)0.146Clinic SBP (mmHg)125 ± 9155 ± 13<0.001Clinic DBP (mmHg)75 ± 781 ± 80.003Daytime systolic ABPM (mmHg)114 ± 10121 ± 100.007Daytime diastolic ABPM (mmHg)73 ± 772 ± 70.586Central SBP (mmHg)118 ± 8145 ± 13<0.001Central DBP (mmHg)76 ± 782 ± 80.004QKD100−60 interval (msec)208 ± 18197 ± 260.114Non-dipper, n (%)16 (57)14 (50)0.592Stroke typeTIA, n (%)25 (78)16 (53)0.039Lacunar, n (%)7 (22)14 (47)Data expressed as mean ± standard deviation or number (percentage). Significance determined by t-test. Chi-squared used for: anti-hypertensive use, male gender, dipping status and stroke type.