Background: The long-term cardiovascular risk of isolated elevated office blood pressure (BP) is unclear. Purpose: To summarize the risk for cardiovascular events and all-cause mortality associated with untreated white coat hypertension (WCH) and treated white coat effect (WCE). Data Sources: PubMed and EMBASE, without language restriction, from inception to December 2018. Study Selection: Observational studies with at least 3 years of follow-up evaluating the cardiovascular risk of WCH or WCE compared with normotension. Data Extraction: 2 investigators independently extracted study data and assessed study quality. Data Synthesis: 27 studies were included, comprising 25 786 participants with untreated WCH or treated WCE and 38 487 with normal BP followed for a mean of 3 to 19 years. Compared with normotension, untreated WCH was associated with an increased risk for cardiovascular events (hazard ratio [HR], 1.36 [95% CI, 1.03 to 2.00]), all-cause mortality (HR, 1.33 [CI, 1.07 to 1.67]), and cardiovascular mortality (HR, 2.09 [CI, 1.23 to 4.48]); the risk for WCH was attenuated in studies that included stroke in the definition of cardiovascular events (HR, 1.26 [CI, 1.00 to 1.54]). No significant association was found between treated WCE and cardiovascular events (HR, 1.12 [CI, 0.91 to 1.39]), all-cause mortality (HR, 1.11 [CI, 0.89 to 1.46]), or cardiovascular mortality (HR, 1.04 [CI, 0.65 to 1.66]). The findings persisted across several sensitivity analyses. Limitation: Paucity of studies evaluating isolated cardiac outcomes or reporting participant race/ethnicity. Conclusion: Untreated WCH, but not treated WCE, is associated with an increased risk for cardiovascular events and all-cause mortality. Out-of-office BP monitoring is critical in the diagnosis and management of hypertension. Primary Funding Source: National Institutes of Health.
Background: The long-term cardiovascular risk of isolated elevated office blood pressure (BP) is unclear. Purpose: To summarize the risk for cardiovascular events and all-cause mortality associated with untreated white coat hypertension (WCH) and treated white coat effect (WCE). Data Sources: PubMed and EMBASE, without language restriction, from inception to December 2018. Study Selection: Observational studies with at least 3 years of follow-up evaluating the cardiovascular risk of WCH or WCE compared with normotension. Data Extraction: 2 investigators independently extracted study data and assessed study quality. Data Synthesis: 27 studies were included, comprising 25 786 participants with untreated WCH or treated WCE and 38 487 with normal BP followed for a mean of 3 to 19 years. Compared with normotension, untreated WCH was associated with an increased risk for cardiovascular events (hazard ratio [HR], 1.36 [95% CI, 1.03 to 2.00]), all-cause mortality (HR, 1.33 [CI, 1.07 to 1.67]), and cardiovascular mortality (HR, 2.09 [CI, 1.23 to 4.48]); the risk for WCH was attenuated in studies that included stroke in the definition of cardiovascular events (HR, 1.26 [CI, 1.00 to 1.54]). No significant association was found between treated WCE and cardiovascular events (HR, 1.12 [CI, 0.91 to 1.39]), all-cause mortality (HR, 1.11 [CI, 0.89 to 1.46]), or cardiovascular mortality (HR, 1.04 [CI, 0.65 to 1.66]). The findings persisted across several sensitivity analyses. Limitation: Paucity of studies evaluating isolated cardiac outcomes or reporting participant race/ethnicity. Conclusion: Untreated WCH, but not treated WCE, is associated with an increased risk for cardiovascular events and all-cause mortality. Out-of-office BP monitoring is critical in the diagnosis and management of hypertension. Primary Funding Source: National Institutes of Health.
Authors: Mahboob Rahman; Xue Wang; Joshua D Bundy; Jeanne Charleston; Debbie Cohen; Jordana Cohen; Paul E Drawz; Lama Ghazi; Edward Horowitz; James P Lash; Sarah Schrauben; Matthew R Weir; Dawei Xie; Raymond R Townsend Journal: J Am Soc Nephrol Date: 2020-09-24 Impact factor: 10.121
Authors: Jordana B Cohen; Debbie L Cohen; Daniel S Herman; John T Leppert; James Brian Byrd; Vivek Bhalla Journal: Ann Intern Med Date: 2020-12-29 Impact factor: 25.391
Authors: Laura P Cohen; Demetria Hubbard; Calvin L Colvin; Byron C Jaeger; Bharat Poudel; Marwah Abdalla; Aisha T Langford; Shakia T Hardy; Mario Sims; Cora E Lewis; Paul Muntner; Daichi Shimbo Journal: Am J Hypertens Date: 2021-11-20 Impact factor: 3.080