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Untreated white coat hypertension ups risk of cardiovascular events, all-cause mortality

20 Jun 2019
29 sources of inaccuracy have been identified in the measurement of adults’ resting blood pressure in clinical settings.

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.

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