Short- and long-term risk of cardiovascular events in white-coat hypertension

The prognostic impact of white-coat hypertension is notyet completely clear. In this study, we investigatedcardiovascular outcome in sustained hypertension,white-coat hypertension and normotension in the shortand long term. The occurrence of fatal and nonfatalcardiovascular events was evaluated in 1732 subjectswith clinical hypertension (1333 with sustained and 399with white-coat hypertension) and 305 with normo-tension. White-coat hypertension was defined asclinical hypertension and daytime blood pressureo135/85mmHg. During the period of observation (mean6.4 years, range 0.7–13.1), 152 cardiovascular eventsoccurred. The event rate per 100 patient-years in subjectswith normotension, white-coat and sustained hyperten-sion was 0.38, 0.44 and 1.58, respectively. Event-freesurvival was significantly different among the groups(Po0.0001). After adjustment for several covariates, Coxregression analysis showed that cardiovascular risk wassignificantly higher in patients with sustained than inthose with white-coat hypertension (relative risk (RR)3.32, 95% confidence interval (CI) 1.81–6.12, P¼0.0001),whereas there was no significant difference betweennormotension and white-coat hypertension. When eventswere analysed separately, cardiac and cerebrovascularrisk were significantly higher in sustained than in white-coat hypertension (RR 4.16, 95% CI 1.48–11.6, P¼0.007,and RR 4.12, 95% CI 1.62–10.5, P¼0.003, respectively)and not significantly different between white-coat hyper-tension and normotension. Event-free survival had thesame trend for the whole period of observation bothwhen cardiovascular events were examined together andwhen cardiac and cerebrovascular events were analysedseparately. In this study, cardiovascular risk in white-coathypertension was significantly lower than that in sus-tained hypertension and not significantly different fromnormotension both in the short and long term.Journal of Human Hypertension (2008) 22, 408–414;doi:10.1038/jhh.2008.6; published online 21 February 2008Keywords: ambulatory blood pressure monitoring; white-coat hypertension; prognosis