Cardiac and carotid structure in patients with established hypertension and white-coat hypertension

Aim: The introduction of ambulatory blood pressure monitoring in the clinical practice has defined a new subgroup of hypertensive patients called white-coat hypertensives. It has been reported that white-coat hypertensives have less cardiac involvement than established hypertensive patients. This study was designed to examine the extent of cardiac and vascular involvement in patients with white-coat hypertension and established hypertension. Patients and methods: We studied 82 patients with mild essential hypertension, never previously treated, using 24-h ambulatory blood pressure monitoring and an echocardiographic and vascular ultrasonographic study. Left ventricular dimensions and mass were obtained according to the Penn convention. The intima-media thickness of the posterior wall of both common carotid arteries was measured 5, 10 and 20 mm caudally to the flow-divider and the average value was used for analysis. Results: Of the 82 patients, 31 (mean±SD age 35 ±10 years) had average 24-h systolic/diastolic blood pressure values of below 1 32/85 mmHg (white-coat hypertensives) and 51 (aged 42±2 years) had a consistently elevated diastolic blood pressure. Both groups had similar body surface area (1.82±0.22 versus 1.81 ±0.22 m2), sex distribution (20 males and 11 females versus 32 males and 19 females), duration of hypertension, metabolic parameters and smoking habit. The 24-h ambulatory blood pressure monitoring values were, by definition, significantly higher in established hypertensives than in white-coat hypertensives (142±10/94±6 versus 1 27±6/79±4 mmHg, P<0.001). The left ventricular mass index and intima-media thickness were significantly higher in the established hypertensives (112± 1 7 g/m2, 0.67±0.11 mm, respectively) than in the white-coat hypertensives (98±18g/m2, 0.58 ±0.09 mm; P< 0.001 for both). Conclusions: The prevalence of left ventricular hypertrophy and cardiac remodeling was significantly more frequent in established hypertensives (51%) compared to white-coat hypertensives (19%). These confirm that structural changes in the left ventricle in white-coat hypertensives are more limited than in established hypertensives and show that in white-coat hypertensives there is significantly less involvement of the conductance vessels than in established hypertensives