Published Online
on December 13, 2004

A more recent version of this article appeared on February 1, 2005

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Submitted on July 15, 2004
Revised on July 30, 2004

Short- and Long-Term Incidence of Stroke in White-Coat Hypertension

Paolo Verdecchia^*; Gian Paolo Reboldi; Fabio Angeli; Giuseppe Schillaci; Joseph E. Schwartz; Thomas G. Pickering; Yutaka Imai; Takayoshi Ohkubo; and Kazuomi Kario

From the Dipartimento Malattie Cardiovascolari (P.V., F.A.), Ospedale R. Silvestrini, Perugia, Italy; Dipartimento Medicina Interna (G.P.R.), Università degli Studi di Perugia, Italy; Medicina Interna (G.S.), Angiologia e Malattie da Arteriosclerosi, Università degli Studi di Perugia, Italy; Department of Psychiatry and Behavioral Science (J.E.S.), State University of New York, Stony Brook; Behavioral Cardiovascular Health and Hypertension Program PH-9 946 (T.G.P.), Columbia University College of Physicians and Surgeons, New York, NY; Department of Clinical Pharmacology and Therapeutics (Y.I., T.O.), Tohoku University Graduate School of Medicine and Pharmaceutical Science, Sendai, Japan; and Department of Cardiology (K.K.), Jichi Medical School, Tochigi, Japan.

^* To whom correspondence should be addressed. E-mail: verdec{at}tin.it.

Abstract--White-coat hypertension (WCH) has been associated with a low risk for stroke, but long-term data are scanty. We analyzed individual data from 4 prospective cohort studies from the United States, Italy, and Japan that used comparable methodology for 24-hour noninvasive ambulatory blood pressure monitoring (ABPM). Overall, 4406 subjects with essential hypertension and 1549 healthy normotensive controls who were untreated at the time of initial ABPM were followed for a median of 5.4 years up to censoring or occurrence of a first stroke. At entry, mean age of subjects was 56 years (range 18 to 97). Prevalence of WCH was 9%. During follow-up, there were 213 new cases of stroke. Stroke rate (x100 person years) was 0.35 in the normotensive group, 0.59 in the WCH group, and 0.65 in the group with ambulatory hypertension. In a multivariate analysis, the adjusted hazard ratio for stroke was 1.15 (95% confidence interval [CI], 0.61 to 2.16) in the WCH group (P=0.66) and 2.01 (95% CI, 1.31 to 3.08) in the ambulatory hypertension group (P=0.001) compared with the normotensive group. After the sixth year of follow-up, the incidence of stroke tended to increase in the WCH group, and the corresponding hazard curve crossed that of the ambulatory hypertension group by the ninth year of follow-up. In conclusion, WCH was not associated with a definitely increased risk of stroke during the total follow-up period. However, WCH might not be a benign condition for stroke in the long term.

Key words: blood pressure monitoring, ambulatory • stroke • blood pressure

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