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White-coat hypertension is a risk factor for cardiovascular diseases and total mortality

Huang, Yuli; Huang, Weijun; Mai, Weiyi; Cai, Xiaoyan; An, Dongqi; Liu, Zhuheng; Huang, He; Zeng, Jianping; Hu, Yunzhao; Xu, Dingli

doi: 10.1097/HJH.0000000000001226

Background: Whether white-coat hypertension (WCH) is an innocent phenomenon is controversial.

Method: In this study, we evaluated the association of WCH and the risk of cardiovascular diseases (CVDs) and mortality, stratified by baseline antihypertensive treatment status. Databases (PubMed, EMBASE, CINAHL Plus, Scopus, and Google Scholar) were searched for prospective studies with data on CVD and total mortality associated with WCH. The primary outcomes were the risk of CVD and total mortality associated with WCH stratified by antihypertensive treatment status. The relative risks of events compared with normotension were calculated.

Results: A total of 23 cohorts (20 445 individuals), 11 cohorts (8656 individuals), and 12 cohorts (21 336 individuals) were included for analysis of cardiovascular risk associated with WCH in patients without baseline antihypertensive treatment (untreated), or under antihypertensive treatment (treated) or mixed population (including both untreated and treated patients), respectively. In untreated cohorts, WCH was associated with a 38 and 20% increased risk of CVD and total mortality compared with normotension, respectively. In the mixed population, WCH was associated with a 19 and 50% increased risk of CVD and total mortality. However, in the treated patients, neither the risk of CVD, nor total mortality was increased in WCH. Meta-regression analyses indicated that neither differences of clinic blood pressure, nor out-of-office blood pressure variables were correlated with risk of CVD in WCH.

Conclusion: We concluded that WCH is associated with long-term risk of CVD and total mortality in patients without antihypertensive treatment. Close follow-up should be performed in WCH patients.

aDepartment of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou

bDepartment of Cardiology, The Affiliated Hospital at Shunde (the First People's Hospital of Shunde), Southern Medical University

cDepartment of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou

dDepartment of Cardiology, the Central Hospital of Xiangtan, Xiangtan, PR China

Correspondence to Professor Dingli Xu, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, PR China. Tel: +86 20 61641493; fax: +86 20 61360416; e-mail:; Professor Yunzhao Hu, Department of Cardiology, the Affiliated Hospital at Shunde (the First People's Hospital of Shunde), Southern Medical University. Tel: +86 757 22318680; fax: +86 757 22318399; e-mail:

Abbreviations: ABPM, ambulatory blood pressure monitoring; BP, blood pressure; CIs, confidence intervals; CVD, cardiovascular disease; HBPM, home blood pressure monitoring; HRs, hazard ratios; IDACO, International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes Population; MOOSE, Meta-analysis of Observational Studies in Epidemiology; RRs, relative risks; SEs, standard errors; WCH, white-coat hypertension

Received 19 July, 2016

Revised 2 October, 2016

Accepted 28 November, 2016

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