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The Cardiovascular Risk of White-Coat Hypertension

SS. Franklin, L. Thijs, K. Asayama, Y. Li, TW. Hansen, J. Boggia, L. Jacobs, Z. Zhang, M. Kikuya, K. Björklund-Bodegård, T. Ohkubo, WY. Yang, J. Jeppesen, E. Dolan, T. Kuznetsova, K. Stolarz-Skrzypek, V. Tikhonoff, S. Malyutina, E. Casiglia, Y....

. 2016 ; 68 (19) : 2033-2043.

Language English Country United States

Document type Journal Article, Multicenter Study

Persistent link   https://www.medvik.cz/link/bmc17031308

BACKGROUND: The role of white-coat hypertension (WCH) and the white-coat-effect (WCE) in development of cardiovascular disease (CVD) risk remains poorly understood. OBJECTIVES: Using data from the population-based, 11-cohort IDACO (International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes), this study compared daytime ambulatory blood pressure monitoring with conventional blood pressure measurements in 653 untreated subjects with WCH and 653 normotensive control subjects. METHODS: European Society Hypertension guidelines were used as a 5-stage risk score. Low risk was defined as 0 to 2 risk factors, and high risk was defined as ≥3 to 5 risk factors, diabetes, and/or history of prior CVD events. Age- and cohort-matching was done between 653 untreated subjects with WCH and 653 normotensive control subjects. RESULTS: In a stepwise linear regression model, systolic WCE increased by 3.8 mm Hg (95% confidence interval [CI]: 3.1 to 4.6 mm Hg) per 10-year increase in age, and was similar in low- and high-risk subjects with or without prior CVD events. Over a median 10.6-year follow-up, incidence of new CVD events was higher in 159 high-risk subjects with WCH compared with 159 cohort- and age-matched high-risk normotensive subjects (adjusted hazard ratio [HR]: 2.06; 95% CI: 1.10 to 3.84; p = 0.023). The HR was not significant for 494 participants with low-risk WCH and age-matched low-risk normotensive subjects. Subgroup analysis by age showed that an association between WCH and incident CVD events is limited to older (age ≥60 years) high-risk WCH subjects; the adjusted HR was 2.19 (95% CI: 1.09 to 4.37; p = 0.027) in the older high-risk group and 0.88 (95% CI: 0.51 to 1.53; p = 0.66) in the older low-risk group (p for interaction = 0.044). CONCLUSIONS: WCE size is related to aging, not to CVD risk. CVD risk in most persons with WCH is comparable to age- and risk-adjusted normotensive control subjects.

1st Department of Cardiology Interventional Electrocardiology and Hypertension Jagiellonian University Medical College Krakow Poland

Asociación Española Primera de Socorros Mutuos Montevideo Uruguay

Cambridge University Hospitals Addenbrook's Hospital Cambridge United Kingdom

Center for Epidemiological Studies and Clinical Trials Ruijin Hospital Shanghai Jiaotong University School of Medicine Shanghai China

Center for Vascular Evaluation Ruijin Hospital Shanghai Jiaotong University School of Medicine Shanghai China

Centro de Nefrología and Departamento de Fisiopatología Hospital de Clínicas Universidad de la República Montevideo Uruguay

Conway Institute of Biomolecular and Biomedical Research University College Dublin Dublin Ireland

Department of Cardiology Karolinska Institute Danderyd Hospital Stockholm Sweden

Department of Epidemiology Maastricht University Maastricht the Netherlands

Department of Hygiene and Public Health Teikyo University School of Medicine Tokyo Japan

Department of Medicine Glostrup Hospital University of Copenhagen Copenhagen Denmark

Department of Medicine University of Padua Padua Italy

Faculty of Medicine Charles University Pilsen Czech Republic

Heart Disease Prevention Program Division of Cardiology School of Medicine University of California Irvine Irvine California

Institute of Internal Medicine Novosibirsk Russian Federation

Section of Geriatrics Department of Public Health and Caring Sciences Uppsala University Uppsala Sweden

Steno Diabetes Center Gentofte and Research Center for Prevention and Health Gentofte Denmark

Studies Coordinating Centre Research Unit Hypertension and Cardiovascular Epidemiology KU Leuven Department of Cardiovascular Sciences University of Leuven Leuven Belgium

Tohoku University Graduate School of Pharmaceutical Science and Medicine Sendai Japan

Tohoku University Graduate School of Pharmaceutical Sciences Sendai Japan

References provided by Crossref.org

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$a BACKGROUND: The role of white-coat hypertension (WCH) and the white-coat-effect (WCE) in development of cardiovascular disease (CVD) risk remains poorly understood. OBJECTIVES: Using data from the population-based, 11-cohort IDACO (International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes), this study compared daytime ambulatory blood pressure monitoring with conventional blood pressure measurements in 653 untreated subjects with WCH and 653 normotensive control subjects. METHODS: European Society Hypertension guidelines were used as a 5-stage risk score. Low risk was defined as 0 to 2 risk factors, and high risk was defined as ≥3 to 5 risk factors, diabetes, and/or history of prior CVD events. Age- and cohort-matching was done between 653 untreated subjects with WCH and 653 normotensive control subjects. RESULTS: In a stepwise linear regression model, systolic WCE increased by 3.8 mm Hg (95% confidence interval [CI]: 3.1 to 4.6 mm Hg) per 10-year increase in age, and was similar in low- and high-risk subjects with or without prior CVD events. Over a median 10.6-year follow-up, incidence of new CVD events was higher in 159 high-risk subjects with WCH compared with 159 cohort- and age-matched high-risk normotensive subjects (adjusted hazard ratio [HR]: 2.06; 95% CI: 1.10 to 3.84; p = 0.023). The HR was not significant for 494 participants with low-risk WCH and age-matched low-risk normotensive subjects. Subgroup analysis by age showed that an association between WCH and incident CVD events is limited to older (age ≥60 years) high-risk WCH subjects; the adjusted HR was 2.19 (95% CI: 1.09 to 4.37; p = 0.027) in the older high-risk group and 0.88 (95% CI: 0.51 to 1.53; p = 0.66) in the older low-risk group (p for interaction = 0.044). CONCLUSIONS: WCE size is related to aging, not to CVD risk. CVD risk in most persons with WCH is comparable to age- and risk-adjusted normotensive control subjects.
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$a Li, Yan $u Center for Epidemiological Studies and Clinical Trials, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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$a Hansen, Tine W $u Steno Diabetes Center, Gentofte and Research Center for Prevention and Health, Gentofte, Denmark.
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$a Boggia, José $u Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
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$a Kikuya, Masahiro $u Tohoku University Graduate School of Pharmaceutical Science and Medicine, Sendai, Japan.
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$a Björklund-Bodegård, Kristina $u Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Cardiology, Karolinska Institute, Danderyd Hospital, Stockholm, Sweden.
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$a Jeppesen, Jørgen $u Department of Medicine, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
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