Long-term follow-up of adolescents with white coat hypertension: a preliminary exploratory study

White coat hypertension (WCH) in youth has traditionally been considered benign, but it may precede sustained hypertension (SH) and cardiovascular remodelling. We evaluated long-term blood pressure (BP) outcomes and hypertension-mediated organ damage in adolescents with WCH. This preliminary exploratory cohort study included 34 adolescents with WCH and 24 normotensive controls followed for median periods of 8.5 and 7.7 years. Clinical, biochemical, echocardiographic, vascular, and ambulatory BP monitoring (ABPM) assessments were performed at baseline and follow-up. At follow-up, 13 participants with WCH (38.2%) progressed to SH, 2 (5.9%) maintained WCH, and 19 (55.9%) became normotensive; no control developed SH. Participants who progressed had higher baseline ambulatory systolic BP (SBP; 124 vs 119 mmHg, p = 0.004) and pulse pressure (PP; 55 vs 49 mmHg, p = 0.01), while office BP was similar. At follow-up, office BP, ambulatory SBP (131 vs 118 mmHg, p = 0.001), PP (60 vs 45 mmHg, p = 0.003), central SBP (126 vs 121 mmHg, p = 0.032), and augmentation pressure (7 vs 4 mmHg, p = 0.009) were higher in the SH group. Most biochemical parameters, carotid intima-media thickness, and pulse wave velocity were similar between groups. More than one-third of adolescents with WCH progressed to SH. Higher baseline ambulatory SBP and PP may identify those at greater risk. These preliminary findings support individualized, risk-stratified surveillance, with closer ABPM follow-up for adolescents with higher-normal ambulatory BP, wider PP, excess adiposity, persistent office BP elevation, or other cardiovascular risk factors.