[Cardiac and vascular morphology in patients with "white-coat hypertension": echocardiographic and ultrasonographic study]

C Cuspidi, M Marabini, L Lonati, L Sampieri, G Pontiggia, S Pelizzoli, G Leonetti
Giornale Italiano di Cardiologia 1995, 25 (12): 1581-7

BACKGROUND: The introduction of ambulatory blood pressure (ABPM) in the clinical practice has defined a new subgroup of hypertensive patients (pts) called "white coat" hypertensive pts. It has been reported that white coat hypertensive pts have less cardiac involvement than established hypertensive pts. This study was designed to examine the extent of cardiac and vascular involvement in pts with white coat hypertension and established hypertension.

METHODS: Fifty-four previously never treated pts with mild or moderate hypertension underwent a 24h ABPM and an echocardiographic and vascular ultrasonographic study in order to assess left ventricular anatomical parameters and the intima-media thickness of common carotid arteries. Left ventricular dimensions and mass were obtained according to Penn convention. The intima-media thickness of the far wall of both common carotid arteries was measured at 5, 10 and 20 mm caudally to the flow-divider; the average values were considered.

RESULTS: Twenty-eight pts (age 43 +/- 8 years) had an average daytime ABPM below 140/90 mm Hg ("white coat") and 26 pts (age 46 +/- 10) had a consistently elevated diastolic blood pressure. Both groups had similar office blood pressure (152 +/- 9/101 +/- 7 vs 155 +/- 10/103 +/- 6 mm Hg) body surface mass (1.79 +/- 0.23 vs 1.86 +/- 0.21 mq), sex (18M/20F vs 18M/8F), duration of hypertension, glycolipidic parameters and smoking habit. The daytime ABPM was (by definition) significantly higher in established hypertensive pts than in white coat hypertensive pts (145 +/- 11/97 +/- 4 vs 129 +/- 7/83 +/- 5 mm Hg, p < 0.001). Left ventricular mass index and intima-media thickness resulted significantly greater in established (119 +/- 1.7 g/m2; 0.70 +/- 0.11 mm) than in white coat hypertensive pts (99 +/- 16 g/m2; 0.60 +/- 0.1 mm, p < 0.002). The prevalence of left ventricular hypertrophy and cardiac remodeling was more frequent in established hypertensive pts (53%) compared to white coat hypertensive pts (7.7%).

CONCLUSION: The results of our study confirm that structural changes of left ventricle in white coat hypertensive pts are more limited than in established hypertensive pts and for the first time show that in white coat hypertensive pts the involvement of the conductance vessels is significantly lower than in established hypertensive pts.

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