Long-term followup of untreated white-coat hypertensive patients.

Recent cross-sectional and prognostic studies of white-coat hypertension (WCH) have suggested that an office BP > 140/90 mmHg is not predictive of hypertensive morbidity when the awake ambulatory BP is < 135/85 mmHg. To evaluate the long-term changes in office and ambulatory BP, and the white-coat effect (office-awake BP), we restudied untreated WCH patients (office BP > 140/90 mmHg with awake BP < 135/85 mmHg and white-coat effect > 20 mmHg systolic or 10 mmHg diastolic) who had their first ambulatory BP recording > 12 months previously and had not been treated with antihypertensive drug therapy. Recordings were performed with either Accutracker or QuietTrak recorders under the same environmental conditions. Patients with substantial changes in employment status (e.g., retirement), weight/exercise (>10% change), or drugs that might affect BP were excluded. Studies were performed 37 ± 26 months (range, 15–119 months) apart: *white coat effect (office - awake BP > 20mmHg SBP or 10 mmHg DBP) Only five (12.5%) of the WCH patients developed one or more criteria for ambulatory hypertension (awake BP > 135/85 mmHg or BP load > 30%). Age, duration of hypertension, body mass index, baseline office and ambulatory BPs, and time lapsed between studies did not predict the change in ambulatory BP over time. These data show that 88% of patients with WCH remain as WCH over time and 95% continue to display a white-coat effect. The small subgroup who did become hypertensive over time were not predicted by office BP, ambulatory BP, or age.