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(Hypertension. 2000;35:614.)
© 2000 American Heart Association, Inc.

Scientific Contributions

Attenuation of the "White-Coat Effect" by Antihypertensive Treatment and Regression of Target Organ Damage

Gianfranco Parati; Luisa Ulian; Lorena Sampieri; Paolo Palatini; Alessandra Villani; Alessandro Vanasia; Giuseppe Mancia; on behalf of the Study on Ambulatory Monitoring of Blood Pressure and Lisinopril Evaluation (SAMPLE) Study Group

From the Clinica Medica, University of Milano-Bicocca and Ospedale S. Gerardo, Monza (G.M.); Centro di Fisiologia Clinica e Ipertensione, IRCCS, Ospedale Maggiore Milano (L.S.); Clinica Medica, University of Padua (P.P.); and the Istituto Scientifico Ospedale S. Luca, IRCCS, Istituto Auxologico Italiano, Milan (G.P., L.U., A.Villani, G.M., A. Vanasia), Italy.

Correspondence to Gianfranco Parati, MD, Ospedale S. Luca, IRCCS, Istituto Auxologico Italiano, via Spagnoletto, 3 20149 Milano, Italy. E-mail gparati{at}mailserver.unimi.it

Abstract—This study assessed whether 2 common surrogate measures of the "white-coat effect," namely the clinic-daytime and the clinic-home differences in blood pressure (BP), were attenuated by long-term antihypertensive treatment and whether this attenuation is relevant to the treatment-induced regression of left ventricular hypertrophy, thus having clinical significance. We considered data from 206 patients with essential hypertension (aged 20 to 65 years) who had a diastolic BP between 95 and 115 mm Hg and echocardiographic evidence of left ventricular hypertrophy. In each patient, clinic BP, 24-hour ambulatory BP, and left ventricular mass index were assessed at baseline, after 3 and 12 months of treatment with an angiotensin-converting enzyme inhibitor, and after a final 4-week placebo run-off period. At baseline, the clinic-daytime differences in systolic and diastolic BP were 12.1±15.4 and 6.8±10.1 mm Hg, respectively; the corresponding values for the clinic-home differences were 5.7±10.6 and 2.9±6.1 mm Hg, respectively. These differences were reduced by 57.6% and 77.1% (P<0.01) and by 65.7% and 64.3% (P<0.01), respectively, after 12 months of treatment, with a partial return toward the pretreatment differences after the final placebo period. The observed treatment-induced reductions in left ventricular mass index and those in the clinic-daytime or clinic-home differences for systolic and diastolic BP showed no significant relationship when tested by multiple regression analysis. This provides the first longitudinal evidence that clinic-daytime and clinic-home differences in BP have no substantial value in predicting the regression of target organ damage, such as left ventricular hypertrophy, that has prognostic relevance.

Key Words: blood pressure • hypertension, white-coat • antihypertensive agents

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