Untreated white-coat hypertension is linked to increased mortality, CV events

  • Cohen JB & al.
  • Ann Intern Med
  • 11 Jun 2019

  • International Clinical Digest
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Takeaway

  • Untreated white-coat hypertension (WCH) is linked to increased all-cause mortality risk and increased risk for cardiovascular events, according to findings of this meta-analysis. 
  • Treated white-coat effect (WCE), however, is not.

Why this matters

  • Accompanying editorial : the findings support US and European recommendations for out-of-office monitoring, to distinguish WCH from sustained hypertension and WCE from refractory hypertension to avoid intensifying treatment unnecessarily.

Key results

  • Vs normotensive readings, untreated WCH is linked to increased CV event risk (21 studies): 
    • HR, 1.36 (95% CI, 1.03-2.00).
  • Treated WCE was not: 
    • HR, 1.12 (95% CI, 0.91-1.39).
  • If they were not stratified by treated/untreated, however, neither was associated with increased CV risk: HR, 1.26 (95% CI, 0.95-1.73).
  • Stratified by treated/untreated, untreated WCH was linked to increased all-cause mortality risk:
    • HR, 1.33 (95% CI, 1.07-1.67).
  • Treated WCE was not:
    • HR, 1.11 (95% CI, 0.89-1.46).
  • CV mortality risk was increased with WCH:
    • HR, 2.09 (95% CI, 1.23-4.48).
  • It was not increased with treated WCE: 
    • HR, 1.04 (95% CI, 0.65-1.66).

Study design

  • Meta-analysis, 27 studies (international) with 29 cohorts totaling 25,786 with WCH/WCE and 38,487 with normal or controlled BP, followed for mean of 3-19 years. 
  • Funding: NIH.

Limitations

  • Residual confounding possible.
  • Studies tended not to adjust for out-of-office measures.