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White-coat hypertension and cardiovascular events: a meta-analysis

Briasoulis, Alexandros; Androulakis, Emmanuel; Palla, Mohan; Papageorgiou, Nikolaos; Tousoulis, Dimitris

doi: 10.1097/HJH.0000000000000832

Background: White-coat hypertension (WCH) is a frequent condition particularly in children and elderly individuals. The prognostic significance of WCH is still a matter of debate.

Methods: The present study was designed to systematically review cohort studies and assess the effects of WCH compared with normotension and sustained HTN on cardiovascular events and death, stroke, and all-cause mortality. We systematically searched the electronic databases, MEDLINE, PUBMED, EMBASE, and Cochrane for prospective cohort studies, which evaluated participants with office, and ambulatory, and/or home blood pressure.

Results: We included 14 studies with a total number of 29 100 participants (13 538 normotensive patients, 4806 with WCH and 10 756 with sustained HTN) with mean age of 59 years and follow-up of 8 years. Individuals with WCH had higher rates of cardiovascular disease morbidity and mortality but not significantly different all-cause mortality and stroke risk compared with normotensive patients. Cardiovascular disease morbidity and mortality, all-cause mortality, and stroke rates were significantly increased in patients with sustained HTN compared with WCH.

Conclusion: The cardiovascular morbidity and mortality associated with WCH may be slightly higher compared with normotension but well below the risks associated with sustained HTN.

aDivision of Cardiology, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA

bJohn Radcliffe Hospital, University of Oxford, Oxford

cBarts Heart Centre, St Bartholomew's Hospital, London, UK

dDepartment of Cardiology, Hippokration Hospital, University of Athens, Athens, Greece

Correspondence to Alexandros Briasoulis, MD, Department of Cardiology, Wayne State University, Detroit Medical Center, Detroit, MI 48226, USA. E-mail:

Abbreviations: ABP, ambulatory blood pressure; CI, confidence interval; CVD, cardiovascular disease; HTN, hypertension; I2, statistic of inconsistency; OBP, office blood pressure; OR, odds ratio; WCH, white-coat hypertension

Received 6 September, 2015

Revised 18 October, 2015

Accepted 20 November, 2015

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