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Hypertension, Vol 22, 766-770, Copyright © 1993 by American Heart Association
P Gosse, H Promax, P Durandet and J Clementy
The superiority of ambulatory blood pressure monitoring over casual blood
pressure measurement for the prediction of target-organ damage is now well
established, although the significance of "white coat" hypertension is
still controversial. Is an office blood pressure measurement that is higher
than the mean ambulatory value an added risk? Because left ventricular
hypertrophy is a potent risk factor, the effect of hypertension on left
ventricular mass merits attention. Left ventricular mass indexed for height
was measured by M-mode echocardiography in 204 essential hypertensive
patients (140 males, 64 females; mean age [SD], 50 [11] years). Blood
pressure over 24 hours was monitored routinely with a noninvasive
auscultatory device. Office blood pressure after 10 minutes of the subject
in the supine position was measured by the same physician under the same
conditions. The white coat effect was defined as the difference between the
office and average daytime values of systolic and diastolic blood
pressures. Patients were divided into four quartiles according to their
office and daytime blood pressures. Two-way analysis of variance was used
to assess the influence of the white coat effect at a given level of
daytime blood pressure on left ventricular mass. Left ventricular mass
increased significantly (P < .001) with daytime systolic blood pressure
but was independent of white coat effect for both the whole population and
the 143 untreated patients. We conclude that the white coat effect has no
influence on left ventricular mass, favoring the view that white coat
hypertension is a benign condition.
ARTICLES
'White coat' hypertension. No harm for the heart
Hopital Cardiologique, Pessac, France.
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