White-coat hypertension defined by 24-h ABP <125/75 mmHg did not increase MACE risk versus normotension (HR 0.94; 95% CI 0.42-2.10), but risk was higher using a <130/80 mmHg threshold (HR 1.79).
Cohort (n=3,610)
Does the definition of white-coat hypertension based on different 24-h ABP thresholds affect the long-term risk of MACE and mortality compared to normotension in individuals without prior cardiovascular disease?
White-coat hypertension defined by a stricter 24-h ABP threshold (<125/75 mmHg) identifies patients at low long-term risk of MACE and death, whereas a higher threshold (<130/80 mmHg) is associated with increased risk.
Effect estimate: HR 0.94 (95% CI 0.42-2.10)
BACKGROUND: Different definitions of white-coat hypertension (WCH) may explain its variable outcome across studies. METHODS: In an Italian study started in 1986, we followed 3,153 people with (office blood pressure (BP) >=140/90 mmHg) and 457 without office hypertension for a mean of 10.4 years. None had previous cardiovascular disease. All underwent 24-h ambulatory BP (ABP) monitoring. We defined white-coat hypertension (WCH) as an average 24-h ABP < 130/80 mmHg or <125/75 mmHg. The primary outcome was a composite of major adverse cardiovascular events (MACE) and all-cause mortality. RESULTS: Baseline office BP was 156/97 mmHg in people with and 127/81 mmHg without hypertension. At follow-up, MACE events were 344 and 23, and all-cause deaths were 318 and 24 in people with and without hypertension, respectively. Compared to normotensive group, MACE risk was not higher in people with WCH and 24-h ABP < 125/75 mmHg (hazard ratio (HR), 0.94; 95% confidence interval (CI), 0.42-2.10). Compared to normotensive group, MACE risk was higher in people with WCH and 24-h ABP < 130/80 mmHg (HR: 1.79; 95% CI, 1.07-2.29). All-cause death did not differ between the normotensive group and people with WCH and 24-h ABP < 125/75 mmHg (HR 1.37; 95% CI, 0.68-2.73), but it was higher than in the normotensive group when WCH was defined by a 24-h ABP < 130/80 mmHg (HR 1.82; 95% CI, 1.55-3.58). CONCLUSIONS: WCH defined by an average 24-h ABP < 125/75 mmHg identifies people at low risk of MACE and death in the long term. Even modestly above these threshold values, the risk associated with WCH increases.
Verdecchia et al. (Thu,) conducted a cohort in White-coat hypertension (n=3,610). White-coat hypertension vs. Normotension was evaluated on Composite of major adverse cardiovascular events (MACE) and all-cause mortality (HR 0.94, 95% CI 0.42-2.10). White-coat hypertension defined by 24-h ABP <125/75 mmHg did not increase MACE risk versus normotension (HR 0.94; 95% CI 0.42-2.10), but risk was higher using a <130/80 mmHg threshold (HR 1.79).
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