White Coat: Effect As A Subclinical Target Organ Damage Marker

Objective: “White-coat” (WC) effect designs those hypertensive subjects with “uncontrolled” office blood pressure (BP) but normal BP values when assessed by ambulatory BP monitoring (ABPM) or home BP monitoring (HBPM). Cardiovascular risk (CVR) is lower than those with real uncontrolled BP but it still remains unclear if it is equiparable to those well controlled hypertensive subjects. The aim of this study was to assess the prognostic CVR value of WC effect regarding subclinical target organ damage (TOD) in a cohort of hypertensive subjects. Design and method: We designed a retrospective cohort study. The study population included 344 hypertensive patients and they all underwent a complete annual medical examination from January 2011 to December 2014, including 48-hours blood pressure monitoring (ABPM) in order to diagnose those with WC effect. Following examinations were held: carotid artery ultrasound with intima/media thickness (IMT), carotid femoral PWV by Sphygmocor At Cor® and oscillometric measurement of ABI. Blood and urine samples were used for the determination of glomerular filtration rate by MDRD equation (GFR) and Sokolow-Lyon criteria for left ventricular hypertrophy (LVH). Results: WC effect was present on one fifth of subjects (n: 69; 20.1%). When compared with “well controlled” hypertensive subjects (n: 75; 21.8%), we didn[Combining Acute Accent]t find any differences on gender, age, body mass index or nocturnal blood pressure falling. There were greater incidence on LVH incidence rate (21.7 Vs 7.7%) and PWV (11.3 m/sec Vs 9.5 m/sec). We didn[Combining Acute Accent]t find significant differences regarding ABI, IMT or GFR. Finally, estimated risk of any TOD was over 60% (RR: 2.23; 95%CI: 1.3–3–8) when WC effect was present (Vs 41.1% on well controlled hypertensive subjects). Conclusions: Those hypertensive subjects with WC effect had higher incidence rate of subclinical TOD tan those with well controlled blood pressure. We suggest that both ABPM and HBPM help us to better identify hypertensive subjects at poor CV prognosis.