Abstract 4896: White-coat Hypertension and Left Ventricular Hypertrophy: Findings From the HARVEST Study
White-coat hypertension (WCH) is considered a benign clinical condition, but recent studies indicate that patients with WCH may be at increased risk of events. Aim of this study was to evaluate the risk of left ventricular hypertophy (LVH) in this hypertension category in the population of HARVEST study: 470 never-treated young adults (330 men) with a mean age of 33.8 ± 8.5 years (range, 18 to 45 years), who were screened for stage 1 hypertension on at least two occasions, were enrolled. Patients were seen every six months for clinic blood pressure ( BP) and global risk assessment to determine which subjects developed hypertension needing drug therapy (HT). Echocardiographic left ventricular mass (LVM) and 24h ambulatory blood pressure (ABP) were measured at entry, every 5 years, and/or at the time of HT development before starting treatment. Subjects were divided according to whether they had WCH (n = 184) or sustained hypertension (SH, n = 286) at baseline. ABP and LVM measured at baseline and at the end of follow-up were used for analysis. LVH was defined as a LVM ≥50 g/m2.7 in men and ≥47 g/m2.7 in women.
Results. During a 8.5 year follow-up, similar percents of subjects developed LVH (WCH, 8.2% vs SH, 6.3%, p = n.s.). LVM increased by 1.8 ± 6.4 g/m2.7 in WCH and by 0.7 ± 6.9 g/m2.7 in SH (p adjusted for age, sex, BMI, baseline LVM, and time = n.s.). ABP from baseline to study-end rose by 7.9 ± 10.8/5.6 ± 7.2 mmHg in WCH and by 1.2 ± 10.9/1.9 ± 7.9 mmHg in SH (adjusted p for WCH vs SH < 0.000). WCH had a greater increase in ABP than SH also from the 3-month to the study-end measurement (+ 6.2 ± 9.7/4.3 ± 8.2 vs 2.4 ± 12.3/2.8 ± 8.6 mmHg, p = 0.009 for systolic BP, and p = 0.02 for diastolic BP). When data were adjusted also for baseline ABP, no significant difference emerged between WCH and SH for all comparisons.
Conclusions. A greater increase in ABP and body weight and a similar susceptibility to develop LVH was observed in WCH compared to SH, suggesting that WCH should not be regarded as a benign condition. This implies an increased risk of cardiovascular events and prompts for a more tight clinical control along with target organ surveillance in WCH subjects.