White coat hypertension may be a predictor of cardiovascular disease or stroke in high-risk patients aged 60-years and older, according to research published Oct. 31 in the Journal of the American College of Cardiology.

Stanley S. Franklin, MD, FACC, and colleagues examined 653 patients identified with white coat hypertension from the International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes and compared them to 653 patients of similar age and risk for developing cardiovascular disease.

During a follow up period of 10.6 years, the researchers found no difference in the number of new cardiovascular-related heath events between the subjects younger than 60-years-old, with normal blood pressure and those of a similar age and risk profile with white coat hypertension. However, a difference was seen in older patients. Out of 92 high-risk subjects age 60 and older, there were 18 more new cardiovascular events in the follow up period for those diagnosed with white coat hypertension than the same number of subjects of similar age and otherwise similar risk profile with normal blood pressure. 

Researchers said the results support the hypothesis that a small number of patients considered to have white coat hypertension actually have isolated systolic hypertension, which can be an indicator of risk for future cardiovascular disease or stroke. They conclude that multiple blood pressure readings, including readings outside a clinical setting, are necessary to accurately identify cardiovascular risk, especially in older high-risk patients.

In an accompanying editorial, Giuseppe Mancia, MD, and Guido Grassi, MD, said that the study group may not have been large enough or studied over a long enough time period to identify risk in the younger patients. They add that conclusions about younger patients may not be accurate, and moving forward, more research is needed to fully understand the complexities of white coat hypertension.

“The findings must be viewed as preliminary,” cautions Kim A. Eagle, MD, MACC, editor in chief of ACC.org. “Much larger studies with many more endpoints would be required before we would consider this practice changing. Many other studies of the white coat effect have found very little evidence that this finding, in the absence of hypertension in daily life, confers substantial risk.”

Keywords: Blood Pressure, Blood Pressure Determination, Blood Pressure Monitoring, Ambulatory, Cardiovascular Diseases, Hypertension, Risk Factors, Stroke, White Coat Hypertension

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