Hypertension, Vol 20, 555-562, Copyright © 1992 by American Heart Association
P Verdecchia, G Schillaci, F Boldrini, I Zampi and C Porcellati
The assessment of white coat hypertension is complicated by the lack of
generally agreed-on normal limits of ambulatory blood pressure. To assess
the influence of four of these limits on the prevalence of white coat
hypertension and the corresponding distribution of left ventricular
hypertrophy, we performed 24-hour ambulatory blood pressure monitoring and
echocardiographic studies in 346 untreated patients with essential
hypertension and 47 age-matched normotensive control subjects. The upper
limits of normal daytime ambulatory blood pressure were lower using
standards drawn from clinically normotensive populations than using
standards drawn, partly or entirely, from general populations. The
prevalence of white coat hypertension differed markedly using the different
standards, being 12.1%, 16.5%, 28.9%, and 53.2% (chi 2 = 346.0, p less than
0.0001). Left ventricular mass index averaged 77 g/m2 in the control group,
85 g/m2 in the two groups with white coat hypertension defined by using
standards drawn from normotensive populations (both comparisons not
significant versus control group), and 90 and 98 g/m2 in the two groups
with white coat hypertension defined by using the other two standards (both
p less than 0.01 versus control group). The prevalence of echocardiographic
left ventricular hypertrophy was 0% in the control group, 2.4% and 3.5% in
the two groups with white coat hypertension defined by using standards
drawn from normotensive populations, and 9.0% and 14.7% in the other two
groups with white coat hypertension (p less than 0.05 and p less than 0.01,
respectively, versus control group).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Variability between current definitions of 'normal' ambulatory blood pressure. Implications in the assessment of white coat hypertension
General Hospital R. Silvestrini, Division of Medicine, Perugia, Italy.
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