MedWire News: White-coat hypertension promotes carotid atherosclerosis just as much as does sustained hypertension, research suggests.
"Thus, white-coat hypertensives should not be regarded as having a benign condition, because it may increase susceptibility to vascular complications early in life," the team writes in the journal Hypertension.
Paolo Pauletto (Medicina Interna I, Teviso, Italy) and colleagues measured 24-hour ambulatory blood pressure in 74 grade I hypertensive patients aged 18 to 45 years during a normal working day.
During 5 years of follow-up, the patients' average carotid intima-media thickness (IMT) increased 3.4-fold, and significantly more than the corresponding increase in 20 normotensive controls.
Mean and mean maximal carotid IMT increased by about 0.12 and 0.12 mm, respectively, in the 39 patients with sustained hypertension. The corresponding values were 0.10 and 0.09 mm for the 35 participants with white-coat hypertension, ie, normal blood pressure during daytime hours but hypertension when measured in the office.
The increases in IMT were not significantly different between patients with sustained and white-coat hypertension. But all were significantly greater than the increases of about 0.04 mm for mean and 0.03 mm for mean maximal carotid IMT seen in controls.
In an accompanying editorial, J David Spence (Robarts Research Institute, London, Ontario, Canada) commented: "There is a widespread tendency, which I characterize as wishful thinking, to believe that it is a kindness to withhold therapy in patients with white-coat hypertension.
"Withholding therapy avoids labeling, the cost of therapy, and the adverse effects of antihypertensive drugs."
But Spence argued that white-coat hypertension likely represents stress-reactive hypertension, which has been linked to progression of atherosclerosis and left ventricular mass.
"It must be recognized that the hypothesis that it is safe to withhold therapy in white-coat hypertension remains untested," he noted.
Spence stressed the necessity of a randomized, controlled trial and suggested that, in the meantime, it is prudent to treat white-coat hypertensives. He said: "It is no kindness to withhold therapy that markedly reduces the risk of stroke, cardiovascular disease, and dementia."
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