Untreated White Coat HTN May Increase Cardiovascular Risk

The risk for cardiovascular events and all-cause mortality is increased for individuals with untreated white coat hypertension (WCH) but not for those with treated white coat effect (WCE), according to a review published in the Annals of Internal Medicine.

Jordana B. Cohen, M.D., from the University of Pennsylvania in Philadelphia, and colleagues summarized the risk for cardiovascular events and all-cause mortality using data from 27 studies, with 25,786 participants with untreated WCH or treated WCE and 38,487 with normal blood pressure (BP) followed for a mean of three to 19 years.

The researchers found that untreated WCH correlated with an increased risk for cardiovascular events, all-cause mortality, and cardiovascular mortality compared with normotension (hazard ratios, 1.36 [95 percent confidence interval, 1.03 to 2.00], 1.33 [95 percent confidence interval, 1.07 to 1.67], and 2.09 [95 percent confidence interval, 1.23 to 4.48], respectively); in studies that included stroke in the definition of cardiovascular events, the risk for WCH was attenuated (hazard ratio, 1.26; 95 percent confidence interval, 1.00 to 1.54). Treated WCE was not significantly associated with cardiovascular events (hazard ratio, 1.12; 95 percent confidence interval, 0.91 to 1.39), all-cause mortality (hazard ratio, 1.11; 95 percent confidence interval, 0.89 to 1.46), or cardiovascular mortality (hazard ratio, 1.04; 95 percent confidence interval, 0.65 to 1.66).

"This systematic review and meta-analysis highlights the importance of future trials to evaluate interventions to reduce cardiovascular risk in WCH," the authors write.

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