What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: White coat hypertension (n=547). Intervention: Blood pressure dipping vs. Non-dipping. Primary outcome: Left ventricular hypertrophy (OR 0.68, 95% CI 0.48-0.97, p=0.032).

What question did this study set out to answer?

This study aims to investigate how nocturnal hypertension and non-dipping status affect target organ damage in untreated individuals with white coat hypertension.

April 26, 2026Open Access

Blood pressure determinants of target organ damage among adults with white coat hypertension with a focus on nocturnal hypertension and blood pressure dipping

IPIonas PapasotiriouNational and Kapodistrian University of Athens SSSotiria SpiliopoulouNational and Kapodistrian University of Athens GBGerasimos BarlasAmerican University in Dubai

Key Result

Blood pressure dipping was associated with a 32% lower risk of left ventricular hypertrophy compared to non-dipping in untreated adults with white coat hypertension.

Key Points

This study aims to investigate how nocturnal hypertension and non-dipping status affect target organ damage in untreated individuals with white coat hypertension.
Cross-sectional study of 547 individuals with white coat hypertension conducted at a single institution.
Patient assessments included medical history, office blood pressure measurements, echocardiography, and ambulatory blood pressure monitoring.
Participants were categorized into dippers and non-dippers, as well as nocturnal hypertensives and normotensives.
49.9% of participants were identified as non-dippers, while 33.6% had nocturnal hypertension.
Dippers had a significantly lower risk of left ventricular hypertrophy (OR: 0.68, 95% CI: 0.48 – 0.97) compared to non-dippers.
Higher mean expected eGFR values were observed in dippers (b = 7.03, 95% CI: 3.12 – 10.94) than in non-dippers.

Study Design

Type

Cross-Sectional (n=547)

Multicenter

Structured PICO

Does non-dipping blood pressure status or nocturnal hypertension increase target organ damage in adults with untreated white coat hypertension?

Population

547 adults with untreated white coat hypertension (office SBP ≥140 mmHg or/and DBP ≥90 mmHg and normal 24-h ambulatory BP values <130/80 mmHg), with no history or clinical evidence of hypertension-related complications or secondary causes of arterial hypertension. Mean age 53.8 years, 38.3% male, evaluated at a single institution in Greece.

Intervention

Non-dipping blood pressure status (SBP nocturnal fall <10%) and nocturnal hypertension (nighttime SBP ≥120 mmHg or/and nighttime DBP ≥70 mmHg)

Comparator

Dipping blood pressure status (SBP nocturnal fall >10%) and nocturnal normotension (nighttime SBP <120 mmHg and nighttime DBP <70 mmHg)

Outcome

Target organ damage (TOD) indices: Left ventricular hypertrophy (LVH), intima-media thickness of the common carotid artery (IMT-CCA), and estimated Glomerular Filtration Rate (eGFR)surrogate

In adults with untreated white coat hypertension, a non-dipping blood pressure pattern is significantly associated with an increased risk of left ventricular hypertrophy and reduced renal function.

Main Result

Effect estimate: OR 0.68 (95% CI 0.48-0.97)

p-value: p=0.032

Limitations

Cross-sectional design prevents examining prospective effects of blood pressure parameters on cardiovascular outcomes
Lack of assessment for other organ damage such as brain and peripheral arteries
Use of fixed time intervals to define daytime and nighttime blood pressure

Abstract

Abstract White coat hypertension (WCH) is still a grey zone regarding its management by clinicians, while its link to target organ damage (TOD) is still understudied. The aim of this study was to explore the impact of non-dipping status and nocturnal hypertension on TOD in untreated WCH subjects. A cross-sectional study of 547 individuals with WCH was conducted at a single institution. Patients underwent a thorough clinical examination, including medical history, office BP measurements, echocardiography, carotid artery ultrasonography, serum creatinine level measurements, and ambulatory blood pressure monitoring. Left ventricular hypertrophy (LVH), intima-media thickness of the common carotid artery (IMT-CCA) and estimated Glomerular Filtration Rate (eGFR) were used as TOD indices. The patients were divided into dippers and non-dippers, as well as nocturnal hypertensives and normotensives. Among WCH patients, 49.9% were non-dippers and 33.6% had nocturnal hypertension. Dippers had a significantly lower risk of left ventricular hypertrophy (OR: 0.68, 95%CI: 0.48 – 0.97) and higher mean expected eGFR values (b = 7.03, 95%CI: 3.12 – 10.94) than non-dippers. For IMT-CCA, office systolic and diastolic BP were the only significant predictors (b = 0.02, 95%CI: 0.00 – 0.03 and b = -0.03, 95%CI: -0.05 – -0.01). Office systolic BP was also significantly associated with eGFR (b = -1.68, 95%CI: -2.84 – -0.52). The results of this study indicate that non-dipping status is a significant risk factor for LVH and renal function in WCH subjects. Therefore, nighttime BP patterns, especially non-dipping, should be examined in patients with WCH.

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