Predictive Factors Of The Evolution Of White Coat (Wcht) To Maintained (Mtht) Hypertension

Objective: The importance of WCHT has been equated in relation to hypertensive disease. The purpose of this study was to evaluate the evolution of patients with WCHT over a period of 10 years and seek predictive markers of risk for progression to MTHT. Design and method: 110 patients WCHT were followed for a period of 10 years and clinical, laboratory, and electrocardiogram evaluation and an ambulatory blood pressure measurement (ABPM) were carried out every 6 months. We considered three groups, G1: WCHT at end 10 years; G2: MTHT at end 5 years; G3: MTHT up to 10 years. The model was ANOVA, p < 0.01 (two-tailed). Results: 130 patients, 55 men, 75 women, with a initial age of 57.5 + 9.3 years and a mass index of 28.4 + 4.3 kg/m2. Follow-up of 20 patients was lost. After 5 years MTHT were 45% and after 10 years 70% were MTHT. Analysing the initial parameters, systolic(S) blood pressure(mmHg)(PA) taken in office were G1:148.4 + 9.2; G2:149.2 8.2 and G3:153,3 + 8.2, shown no significant differences(ns) as for in office diastolic G1:92.6 + 8.4; G2:93.4 + 95.1; G3:95.1 + 7.3,(ns). ABPM measurements didn’t show differences as well, S ambulatory G1:118.7 + 6.9; G2:120.5 + 7.9 and G3:122.4 + 6.8,(ns); D ambulatory G1:66.6 + 7.1; G2:68.8 + 6.4 and G3:70.6 + 7.3,ns). Laboratory parameters didn’t present significant differences except for microalbuminuria(mg/24 h) (G1:12.3 + 9.87; G2:29.5 + 14.3 and G3;18.6 + 9.42, p < 0.01) and plasma viscosity index(mPa.A) (G1:1.18 + 0.07;G2:1.27 + 0.08 and G3:1.23 + 0:06, p < 0.01) Conclusions: WCHT can mark the beginning of hypertensive disease in a scenario in which most of the patients will ultimately evolve to MTHT. In this group the prognostic factors were microalbuminuria and plasma viscosity values, the former being an easy access parameter in clinical practice. The patients presenting WCHT and high levels of microalbuminuria tend to present a more rapid evolution to MTHT and should be monitored repeatedly and start therapy as soon as the diagnosis of MTHT is established