Is white coat hypertension associated with arterial disease or left ventricular hypertrophy?

Although white coat hypertension may be present in 20% or more of hypertensive individuals, its prognostic significance is unknown. We compared prognostically relevant measures of target-organ damage among 24 individuals with white coat hypertension and age- and sex-matched groups of sustained hypertensive and normotensive subjects classified by clinical and 24-hour ambulatory blood pressures. Left ventricular and carotid artery structure and function were evaluated by ultrasonography. Left ventricular mass index was similar in white coat hypertensive (82±17 g/m²) and normotensive (78±15 g/m²) subjects but was higher in sustained hypertensive subjects (97±19 g/m², P<.02 and P<.002, respectively). Similarly, carotid artery intimal- medial thickness was greater in the sustained hypertensive group (0.98±0.21 mm) than in the white coat hypertensive (0.84±0.16 mm, P<.05) and normotensive (0.76±0.18 mm, P<.001) groups. The prevalence of discrete atherosclerotic plaques was higher in the sustained hypertensive group (58%) than in the white coat hypertensive (25%, P<.05) and normotensive (21%, P<.02) groups. Cardiac and carotid structure in individuals with white coat hypertension resemble findings in normotensive subjects and differ significantly from those in age- and sex-matched sustained hypertensive subjects. These findings suggest that white coat hypertension may be a benign condition for which pharmacological intervention may not be necessary, a hypothesis that needs to be tested in longitudinal studies with clinical end points.