Adverse Consequences of Masked and White-Coat Hypertension

Study Questions:

Is white-coat hypertension (HTN) and masked HTN associated with increased risk for cardiovascular disease (CVD) events?


Data from the Dallas Heart Study, a multiethnic cohort of adults (ages 18-65 years) without missing information on the key factors measured were used for the present analysis. White-coat HTN was defined as a high clinic blood pressure (BP) (≥140/90 mm Hg) with home BP measures in the non-HTN range (<135/85 mm Hg). Masked HTN was defined as a high home BP (≥135/85 mm Hg) with non-HTN BP readings in the clinic (<140/90 mm Hg). Sustained HTN was defined as high home and clinic BP measures. Measures of aortic pulse wave velocity (by magnetic resonance imaging), urinary albumin-to-creatinine ratio, and cystatin C were collected at baseline. CVD outcomes included incident coronary heart disease, stroke, atrial fibrillation, heart failure, and CV death collected over a median follow-up of 9 years.


A total of 3,027 participants (50% African Americans, 49% women, median age 43 years) were included in the study. White-coat HTN was observed in 3.3% and masked HTN in 17.8% of the cohort. White-coat HTN and masked HTN were both independently associated with increased aortic pulse wave velocity, cystatin C, and urinary-to-creatinine ratio. After controlling for traditional CVD risk factors, and using normotensives as the reference group, white-coat HTN was significantly associated with CVD events (hazard ratio [HR], 2.09; 95% confidence interval [CI], 1.05-4.15). A similar association was observed for masked HTN (HR, 2.03; 95% CI, 1.36-3.03).


The investigators concluded that both white-coat HTN and masked HTN were independently associated with incident CVD events, increases in aortic stiffness, and renal injury. The authors recommend home BP monitoring to be routinely performed for adults.


These data support the use of home BP measures to be collected and routinely reviewed by providers.

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