Differences in Office and Ambulatory Pulse Wave Analysis in Patients with White Coat Hypertension and Other Hypertension Phenotypes

Introduction Increased arterial stiffness is a sign of vascular damage; therefore, assessing it is crucial for evaluating cardiovascular risk. Arterial stiffness parameters such as pulse wave velocity (PWV) and augmentation index (at heart rate 75 bpm, AIX@75) were shown to correlate directly with blood pressure (BP). Aim Since these parameters may consequently be altered in patients with white coat effect (WCE), this study examined differences in office and 24h measurements of these parameters across various BP phenotypes. Methods In this multicenter cross-sectional study, conducted between 2018 and 2023 at three nephrology clinics, office and 24h BP measurements and pulse wave analysis (PWA) of 208 patients were examined. Results 189 patients were included; 48 were diagnosed with controlled hypertension (HTN), 63 with uncontrolled HTN, 22 with a masked HTN phenotype, 30 with WCE, of whom 11 had white coat HTN (WCH) and 19 had white coat uncontrolled HTN (WCUH), and 26 had normal BP. By definition, patients with WCE had significantly higher office peripheral and aortic BP than the respective 24h values (p<0.0001 each). Their AIX@75 was significantly higher on office (32.7±11.4%) than on 24h measurement (27.4±7.2%, p=0.0354), and they showed a significantly greater reduction in PWV between office and 24h measurement than normotensives and all other BP phenotypes (padj <0.0001 each). Conclusions In patients with WCE, there are significant differences in arterial stiffness parameters between office and 24h measurements, suggesting that both measurement methods provide complementary hemodynamic information. Prospective studies are needed to determine the prognostic significance of these differences.