White coat hypertension (N=50) was associated with similar cardiovascular risk factors—including elevated cholesterol, insulin, and triglycerides—as sustained hypertension (N=47).
Observational (n=937)
What are the clinical and pathophysiological characteristics of subjects with white coat hypertension compared to those with sustained hypertension?
White coat hypertension is associated with similar metabolic and cardiovascular risk factors as sustained hypertension, suggesting these patients may benefit from nonpharmacologic interventions to ameliorate coronary risk factors.
Home blood pressure readings by self-monitoring (14 readings in 7 days) have been compared to readings taken in the clinic in 937 participants of the Tecumseh Blood Pressure Study. In the absence of firm criteria "hypertension at home" was defined as having home readings in the upper decile of the whole population. If a clinic reading exceeded 140 and/or 90 mmHg a subject was categorized as having clinic "hypertension". Two hypertensive groups emerged; one with both clinic and home hypertension ("sustained" N = 47) and one with high clinic but normal home blood pressure ("white coat" N = 50). Groups with "white coat" and "sustained" hypertension were very similar. Both groups were overweight, had faster heart rates, elevated cholesterol, insulin, triglyceride and decreased HDL levels. Blood pressure readings at previous exams (age 5, 8, 21 and 22) were elevated in both the "sustained" and white coat hypertension group compared to the normotensive controls. Subjects with white coat hypertension were not hyperresponders to the stress of mental arrythmetrics or to isometric exercise. The white coat hypertensives did not show abnormal anger, excessive submissiveness, or anxiety. The pathophysiology of the reproducible elevation of the clinic blood pressure in the white coat hypertensives remains unclear. Because of a higher risk of coronary heart disease and a risk for late development of sustained hypertension, subjects with white coat hypertension should be counselled on nonpharmacologic methods to control the blood pressure elevation and to ameliorate coronary risk factors.
Julius et al. (1992) conducted an observational in White coat hypertension (n=937). White coat hypertension vs. Sustained hypertension and normotensive controls was evaluated on Cardiovascular risk factors, previous blood pressure readings, and psychological traits. White coat hypertension (N=50) was associated with similar cardiovascular risk factors—including elevated cholesterol, insulin, and triglycerides—as sustained hypertension (N=47).