Key result
White coat effects were independently associated with left ventricular mass index (P<0.01) and pulse wave velocity (P<0.0001), and these relationships were not mediated by nocturnal BP dipping.
Why the study?
Are white coat effects independently associated with left ventricular mass index or arterial stiffness in individuals of African ancestry, independent of nocturnal blood pressure dipping?
Observational (n=750)
Are white coat effects independently associated with left ventricular mass index or arterial stiffness in individuals of African ancestry, independent of nocturnal blood pressure dipping?
White coat effects are independently associated with increased left ventricular mass index and arterial stiffness, and this relationship is not mediated by attenuated nocturnal blood pressure dipping.
Answers are grounded in this paper and cite their sources.
White coat effects may link to organ damage independently of dipping; leaves open causal roles and need for longitudinal studies in African ancestry groups.
BACKGROUND: Whether independent relationships between white coat effects (office minus day (office-day blood pressure (BP))) and organ damage or arterial stiffness may be explained by associations with an attenuated nocturnal BP dipping, has not been determined. METHODS: In 750 participants from a sample of African ancestry, office and 24-hour BP, carotid-femoral pulse wave velocity (PWV) (applanation tonometry and SphygmoCor software) (n = 662), and left ventricular mass indexed to height(2.7) (LVMI) (echocardiography) (n = 463) were determined. RESULTS: Office-day systolic BP (SBP) was correlated with day minus night (day-night) SBP, percentage night divided by day (night/day) SBP, and night SBP (P < 0.0005), and these relationships persisted with adjustments for confounders, including day SBP (P < 0.005). With adjustments for 24-hour SBP and additional confounders, office-day SBP was associated with LVMI (P < 0.01) and PWV (P < 0.0001). With adjustments for day SBP and additional confounders, day-night SBP, percentage night/day SBP, and night SBP were related to PWV (P < 0.05) but not to LVMI (P > 0.44). The relationships between office-day SBP and LVMI or PWV persisted with adjustments for either day-night or percentage night/day SBP (LVMI: P = 0.01; PWV: P < 0.0001) or night SBP (LVMI: P < 0.01; PWV: P = 0.0001), and in product of coefficient mediation analysis with appropriate adjustments, neither indexes of nocturnal BP dipping nor nocturnal BP per se contributed toward the impact of office-day BP on LVMI or PWV (P > 0.09). CONCLUSIONS: In a group of African ancestry, although white coat effects are independently associated with an attenuated nocturnal decrease in SBP, neither decreased BP dipping nor nocturnal BP contribute toward the independent relationships between white coat effects and LVMI or arterial stiffness.
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Maseko et al. (2013) conducted an observational in Blood pressure evaluation (n=750). White coat effects (office minus day blood pressure) was evaluated on Left ventricular mass index (LVMI) and carotid-femoral pulse wave velocity (PWV) (p=<0.01 for LVMI, <0.0001 for PWV). White coat effects were independently associated with left ventricular mass index (P<0.01) and pulse wave velocity (P<0.0001), and these relationships were not mediated by nocturnal BP dipping.
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