Key result
24-h systolic BP variability in white-coat hypertension is linked to ~25% greater target-organ damage per mmHg.
Why the study?
Does higher 24-h systolic blood pressure variability associate with increased subclinical target-organ damage in untreated white-coat hypertension?
Cross-Sectional (n=267)
No
Does higher 24-h systolic blood pressure variability associate with increased subclinical target-organ damage in untreated white-coat hypertension?
Odds Ratio: 1.25 (95% CI 1.05–1.52)
p-value: p=0.018
In untreated white-coat hypertension, higher 24-h systolic blood pressure variability is associated with concurrent subclinical target-organ damage, suggesting it may provide supplementary prognostic information beyond mean ambulatory blood pressure.
Should not yet change white-coat hypertension management; leaves open whether 24-h SBP variability improves risk stratification in prospective studies.
Objective: To compare subclinical target-organ damage (TOD) across normotension (NT), white-coat hypertension (WCH), and mild-to-moderate hypertension (HT), and examine the association of 24-h systolic blood pressure (SBP) variability with concurrent TOD in untreated WCH. Methods: This single-center retrospective cross-sectional study included 267 hospitalized participants who underwent ambulatory blood pressure monitoring between 2012 and 2021 (91 NT, 93 WCH, 83 HT). TOD markers were compared across groups. Within WCH, multivariable models assessed 24-h SBP variability in relation to any TOD, left ventricular hypertrophy (LVH), left ventricular mass index (LVMI), and microalbuminuria (MA), adjusting for age, sex, body mass index, and 24-h mean SBP. Results: Any TOD occurred in 26.4%, 52.7%, and 71.1% of NT, WCH, and HT participants, respectively (P< 0.001). Within WCH, any TOD occurred in 35.5%, 64.5%, and 58.1% across increasing variability tertiles; the unadjusted between-tertile comparison was not statistically significant (P=0.056). Continuous 24-h SBP variability was associated with any TOD (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.05– 1.52), LVH (OR 1.30, 95% CI 1.08– 1.60), LVMI (β=2.23 g/m 2 , 95% CI 0.33– 4.12), and log-transformed MA (β=0.105, 95% CI 0.052– 0.157). The area under the receiver operating characteristic curve was 0.613 for the base model and 0.678 after adding 24-h SBP variability, with better overall fit of the extended model (likelihood-ratio P=0.009). Conclusion: WCH showed an intermediate prevalence of any TOD between NT and mild-to-moderate HT. Within WCH, higher 24-h SBP variability was associated with concurrent TOD after accounting for 24-h mean SBP and basic clinical factors, and may provide Supplementary Information when interpreted alongside mean ambulatory blood pressure. These single-center cross-sectional findings do not establish temporal or causal relationships and require confirmation in prospective multicenter studies.
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Huang et al. (2026) conducted a cross-sectional in White-coat hypertension (n=267). 24-h systolic blood pressure variability was evaluated on Any target-organ damage (TOD) (OR 1.25, 95% CI 1.05-1.52, p=0.018). Among untreated patients with white-coat hypertension, each 1-mmHg increase in 24-h systolic blood pressure variability was associated with higher odds of concurrent target-organ damage (OR 1.25).
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