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White-coat hypertension, as defined by ambulatory blood pressure monitoring, and subclinical cardiac organ damage: a meta-analysis

Cuspidi, Cesarea,b; Rescaldani, Martac; Tadic, Marijanad; Sala, Carlac; Grassi, Guidoa,e; Mancia, Giuseppea,b

doi: 10.1097/HJH.0000000000000416

Aim: The clinical and prognostic relevance of white-coat hypertension (WCH) has not been fully elucidated; in particular, the association of this blood pressure phenotype with suclinical organ damage remains unclear. We performed a systematic meta-analysis in order to provide a comprehensive information on cardiac structural and functional changes in WCH, as defined by ambulatory blood pressure monitoring.

Design: Studies were identified by the following search terms: ‘white-coat hypertension’, ‘isolated clinic hypertension’, ‘cardiac organ damage’, ‘target organ damage’, ‘left ventricle’, ‘left ventricular hypertrophy’, ‘cardiac hypertrophy’, ‘ventricular dysfunction’, and ‘echocardiography’.

Results: A total of 7382 untreated adult patients (2493 normotensive, 1705 WCH, and 3184 hypertensive individuals) included in 25 studies were considered. Left ventricular mass index was higher in WCH than in normotensive patients [standardized difference in mean (SDM) 0.50, P < 0.01]; mitral E/A ratio was lower (SDM −0.27, P < 0.01) and left atrium larger (SDM 0.29, P < 0.05) in WCH than in the normotensive counterparts. Hypertensive patients showed a greater left ventricular mass index (SDM 0.42, P < 0.01), reduced E/A (SDM −0.15, P < 0.01), and larger left atrium diameter (SDM 0.27, P < 0.01) than WCH patients.

Conclusions: Our meta-analysis shows that alterations in cardiac structure and function in WCH patients, as defined by ambulatory blood pressure monitoring, are intermediate between sustained hypertensive patients and normotensive controls. The study supports the view that WCH should not be further considered a fully benign entity.

aDepartment of Health Science, University of Milano-Bicocca

bIstituto Auxologico Italiano

cDepartment of Clinical Sciences and Community Health, University of Milan, Milan, Italy

dFondazione, Policlinico di Milano University Clinical Hspital Centre ‘Dragisa Misovic’, Belgrade, Serbia

eIstituto di Ricerche a Carattere Scientifico Multimedica, Sesto San Giovanni, Milan, Italy

Correspondence to Professor Cesare Cuspidi, Istituto Auxologico Italiano, Clinical Research Unit, Viale della Resistenza 23, 20036 Meda, Italy.Tel: +39 0362/772433; fax: +39 0362/772416; e-mail:

Abbreviations: ABPM, ambulatory blood pressure monitoring; BP, blood pressure; BSA, body surface area; LVH, left ventricular hypertrophy; SDM, standardized difference in means; E/A ratio, ratio of early (E) to late (A) peak of mitral inflow velocity; WCH, white-coat hypertension

Received 4 May, 2014

Revised 9 September, 2014

Accepted 9 September, 2014

© 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins