Functional and Structural Heart Conditions Associated With White-Coat Hypertension in Comparison With True Hypertension and Normal Blood Pressure States

Background: This study attempted to evaluate functional and structural cardiac states using echocardiography in patients with white-coat hypertension in comparison with true hypertension and normotensive conditions. Methods: The study population consisted of 72 individuals, aged 25 to 75 years. The subjects were assigned to 4 groups: white-coat hypertensives (n=20), controlled true hypertensives (n=20), uncontrolled true hypertensives (n=12), and a normotensive group (n=20). Whilst the 4 subgroups in the study exhibited a similar gender distribution, the normotensive subjects were significantly younger; however, there was no discrepancy in the mean age between the whitecoat hypertensive group and the other hypertensive subgroups. Univariate comparisons between the functional and structural cardiac parameters of the white-coat hypertensives and the other study groups revealed low deceleration time and E'-wave velocity and high E-wave velocity and left ventricular internal dimension indices compared with the other 2 hypertensive groups. Results: After adjustment for sex and age, the white-coat hypertensive group revealed differing results in 2 indices of E' wave velocity and interventricular septal thickness (IVST) when compared with the other three. A number of features were identified as the hallmarks of white-coat hypertensives: specific functional and structural cardiac changes such as low IVST in comparison with the uncontrolled hypertensives; presence of diastolic dysfunction, which was not found in the normotensives; and greater cardiac mass than that in the normotensives, less than that in the uncontrolled hypertensives, but closer to that in the controlled hypertensives. Conclusions: Although the prognosis for patients with white-coat hypertension is not as grave as that for those with true hypertension, it is considerably worse than the prognosis among the normal population.