Untreated white coat hypertension ups risk of cardiovascular events, all-cause mortality
Untreated white coat hypertension (WCH), but not treated white coat effect (WCE), may increase the risk for cardiovascular events and all-cause mortality, suggest the results of a systematic review and meta-analysis. Out-of-office blood pressure (BP) monitoring is thus important in the diagnosis and management of hypertension.
The investigators searched PubMed and Embase for observational studies with at least 3 years of follow-up that assessed the cardiovascular risk of WCH or WCE vs normotension, without language restriction, from inception through December 2018. Two investigators independently extracted data and assessed study quality.
A total of 27 studies were included, comprising 25,786 participants with untreated WCH or treated WCE and 38,487 individuals with normal BP followed for a mean of 3–19 years.
Untreated WCH, compared with normotension, was found to be associated with a higher risk for cardiovascular events (hazard ratio [HR], 1.36, 95 percent CI, 1.03–2.00), all-cause mortality (HR, 1.33, 1.07–1.67) and cardiovascular mortality (HR, 2.09, 1.23–4.48). Studies that included stroke in the definition of cardiovascular events demonstrated a lessened risk for WCH (HR, 1.26, 1.00–1.54).
On the other hand, treated WCE did not show a significant association with cardiovascular events (HR, 1.12, 0.91–1.39), all-cause mortality (HR, 1.11, 0.89–1.46) or cardiovascular mortality (HR, 1.04, 0.65–1.66). These findings were consistent across several sensitivity analyses.
This systematic review and meta-analysis was limited by the paucity of studies evaluating isolated cardiac outcomes or reporting participant race/ethnicity.