Untreated high office blood pressure, sometimes referred to as “white coat hypertension,” was associated with increased risk for adverse cardiovascular events, according to a new meta-analysis.
The researchers, publishing in The Annals of Internal Medicine, searched within PubMed and EMBASE to come up with 27 observational studies (all with at least 3 years of follow-up looking at cardiovascular risk of white coat hypertension or white coat effect versus normotension) comprising 25,786 participants with untreated white coat hypertension or treated white coat effect. The population also included 38,487 patients with normal blood pressure. Data were independently extracted by two study authors and assessed for quality.
Untreated Means Higher Risk
According to the results, untreated white coat hypertension was linked with an increase in risk for cardiovascular events (HR=1.36; 95% CI, 1.03 to 2.00), all-cause mortality (HR=1.33; 95% CI, 1.07 to 1.67) and cardiovascular mortality (HR=2.09; 95% CI, 1.23 to 4.48), an effect which was attenuated in studies that included stroke in the definition of events (HR=1.26; 95% CI, 1.00 to 1.54). The authors also reported no significant association between treated white coat effect and cardiovascular events, all-cause mortality, or cardiovascular mortality. The study results were borne out across several sensitivity analyses, according to the authors.
A lack of studies looking at isolated cardiac outcomes or report participant race/ethnicity were cited as limitations.
Chris Cannon, MD, a cardiologist at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School, told DocWire News that white coat hypertension is very commonly seen in practice, “where we see high blood pressure in the office, but with patients bringing in readings from home that are in the normal range.”
Dr. Cannon added: “This large overview suggests we need to pay close attention, and potentially treat some of these patients. I could envision that some of these “normal” blood pressures patients get are the best days, but there are other days that blood pressure is higher. This study suggests there is risk, so my take away is that I have to look closely and make sure there are a good number of home readings, under stable conditions so that we can really use them. For patients where it is less clear, getting a formal 24-hour ambulatory blood pressure monitor would make good sense, too.”
What do we know about "white coat hypertension"?
1. It is associated with increased risk of major adverse outcomes
2. It's just the tip of the iceberg: "Out of office BP monitoring is critical"https://t.co/zt8s6vhJ7Z@AnnalsofIM + great editorial by @DaichiShimbo & @MuntnerPaul! pic.twitter.com/kbdhFWBe1s
— Eric Topol (@EricTopol) June 10, 2019
Due to mixed results across the existing literature, we asked: Does white coat #hypertension really matter?https://t.co/KLPo7wHUmK#bloodpressure #heartdisease @AnnalsofIM @UPennDBEI @PennKidney @PennMedNews 1/4
— Jordy Cohen, MD, MSCE (@jordy_bc) June 10, 2019
Here is our fresh off the presses Ann Intern Med editorial regarding whether out-of-office monitoring should be done to detect white coat hypertension | https://t.co/LtqajYVGuW | Original article https://t.co/0h7JUSmGRK
— Daichi Shimbo MD (@DaichiShimbo) June 10, 2019
Not a minor issue… 🙃Cardiovascular Events in White Coat Hypertension | Ann Intern Med | ACP | https://t.co/t8kXgia4IZ
— Esteban Jódar Gimeno (@estebanjodar) June 10, 2019