Untreated white coat hypertension was associated with an increased risk for cardiovascular events compared with normotension (HR 1.36; 95% CI 1.03-2.00).
Meta-Analysis (n=64,273)
Does untreated white coat hypertension or treated white coat effect increase the risk of cardiovascular events and mortality compared to normotension?
Untreated white coat hypertension is associated with an increased risk for cardiovascular events and mortality, whereas treated white coat effect is not, emphasizing the need for out-of-office BP monitoring.
Hazard Ratio: 1.36 (95% CI 1.03–2)
Background: The long-term cardiovascular risk of isolated elevated office blood pressure (BP) is unclear. Purpose: To summarize the risk for cardiovascular events and all-cause mortality associated with untreated white coat hypertension (WCH) and treated white coat effect (WCE). Data Sources: PubMed and EMBASE, without language restriction, from inception to December 2018. Study Selection: Observational studies with at least 3 years of follow-up evaluating the cardiovascular risk of WCH or WCE compared with normotension. Data Extraction: 2 investigators independently extracted study data and assessed study quality. Data Synthesis: 27 studies were included, comprising 25 786 participants with untreated WCH or treated WCE and 38 487 with normal BP followed for a mean of 3 to 19 years. Compared with normotension, untreated WCH was associated with an increased risk for cardiovascular events (hazard ratio HR, 1.36 95% CI, 1.03 to 2.00), all-cause mortality (HR, 1.33 CI, 1.07 to 1.67), and cardiovascular mortality (HR, 2.09 CI, 1.23 to 4.48); the risk for WCH was attenuated in studies that included stroke in the definition of cardiovascular events (HR, 1.26 CI, 1.00 to 1.54). No significant association was found between treated WCE and cardiovascular events (HR, 1.12 CI, 0.91 to 1.39), all-cause mortality (HR, 1.11 CI, 0.89 to 1.46), or cardiovascular mortality (HR, 1.04 CI, 0.65 to 1.66). The findings persisted across several sensitivity analyses. Limitation: Paucity of studies evaluating isolated cardiac outcomes or reporting participant race/ethnicity. Conclusion: Untreated WCH, but not treated WCE, is associated with an increased risk for cardiovascular events and all-cause mortality. Out-of-office BP monitoring is critical in the diagnosis and management of hypertension. Primary Funding Source: National Institutes of Health.
Cohen et al. (Mon,) conducted a meta-analysis in White Coat Hypertension (n=64,273). Untreated white coat hypertension (WCH) vs. Normotension was evaluated on Cardiovascular events (HR 1.36, 95% CI 1.03 to 2.00). Untreated white coat hypertension was associated with an increased risk for cardiovascular events compared with normotension (HR 1.36; 95% CI 1.03-2.00).