Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Transiently elevated diastolic blood pressure is associated with a gender-dependent effect on cardiovascular risk


We assessed the morbidity and mortality of subjects with transiently elevated diastolic pressure in the General Practice Hypertension Study Group (GPHSG) population. A total of 23 578 patients (aged 18–65 years) from seven UK general practices were screened in 1974 for a diastolic blood pressure (DBP4) of 90 mmHg. Two further readings of DBP4 determined hypertensive (either DBP490 mmHg) or transient hypertensive (both DBP4<90 mmHg) status. Transients (n=850) were matched with normotensive controls (n=824) and risk ratios calculated over a mean follow-up of 18.7 years. Rescreening was conducted in six of the practices (n=20 942) after 7.7 years. Male transients had a higher relative hazard for cardiovascular mortality than controls (11.8%, 8.6%, adjusted relative hazard 1.59, P=0.056). Female transients had a lower relative hazard for cardiovascular mortality than controls (3.6%, 5.4%, adjusted relative hazard 0.39, P=0.018). In all, 422 patients with transient hypertension were rescreened along with 367 matched controls. Significantly more transients were on antihypertensive treatment compared with their controls (odds ratio (OR) [95% CI]) for both male (4.2 [1.6–11.1]) and female patients (2.4 [1.0–5.56]) and more untreated female transients developed hypertension. Male transients had a higher rates of diabetes mellitus (adj OR=5.1, P=0.04) and stroke (adj OR 15.9, P=0.03). This study has shown that transiently elevated DBP in GPHSG is associated with a significantly higher risk of later hypertension in men and women and of diabetes, stroke and cardiovascular mortality in men. Women with this condition have a significantly lower cardiovascular mortality.

This is a preview of subscription content

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. Mancia G et al. Effects of blood-pressure measurement by the doctor on patient's blood pressure and heart rate. Lancet 1983; 2: 695–698.

    CAS  PubMed  Article  Google Scholar 

  2. Parati G et al. Difference between clinic and daytime blood pressure is not a measure of white coat effect. Hypertension 1998; 31: 1185–1189.

    CAS  PubMed  Article  Google Scholar 

  3. Little P et al. Comparison of agreement between different measures of blood pressures in primary care and daytime ambulatory blood pressure. BMJ 2002; 325: 254–257.

    PubMed  PubMed Central  Article  Google Scholar 

  4. Pickering TG et al. How common is white coat hypertension? JAMA 1988; 259: 225–228.

    CAS  Article  PubMed  Google Scholar 

  5. The Management Committee of the Australian Therapeutic Trial in Mild Hypertension. The Australian therapeutic trial in mild hypertension. Lancet 1980; 1: 1261–1267.

  6. Millar JA, Isles CG, Lever AF . Blood pressure, ‘white-coat’ pressor responses and cardiovascular risk in placebo group patients of the MRC Mild Hypertension trial. J Hypertens 1995; 13: 175–183.

    CAS  PubMed  Article  Google Scholar 

  7. Staessen JA et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997; 350: 757–764.

    CAS  PubMed  Article  Google Scholar 

  8. Hypertension Detection and Follow-up Program Cooperative Group. Variability of blood pressure and the results of screening in the Hypertension Detection and Follow-up Program. J Chron Dis 1978; 31: 651–667.

  9. Amery A et al. Mortality and morbidity results from the European working party on high blood pressure in the elderly trial. Lancet 1985; 1: 1349–1354.

    CAS  PubMed  Article  Google Scholar 

  10. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA 1991; 265: 3255–3264.

  11. MacMahon S et al. Blood pressure, stroke and coronary heart disease. Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 1990; 335: 765–774.

    CAS  PubMed  Article  Google Scholar 

  12. Cerasola G et al. White-coat hypertension and cardiovascular risk. J Cardiovasc Risk 1995; 2: 545–549.

    CAS  PubMed  Article  Google Scholar 

  13. Cardillo C et al. Psychological reactivity and cardiac end-organ changes in White Coat Hypertension. Hypertension 1993; 21: 836–844.

    CAS  PubMed  Article  Google Scholar 

  14. Julius S et al. White Coat’ versus ‘Sustained’ borderline hypertension in Tecumseh, Michigan. Hypertension 1990; 16: 617–623.

    CAS  Article  PubMed  Google Scholar 

  15. Kuwajima I et al. Is white coat hypertension innocent? Structure and function of the heart in the elderly. Hypertension 1993; 22: 826–831.

    CAS  PubMed  Article  Google Scholar 

  16. Liu JE et al. Cardiac and arterial target organ damage in adults with elevated ambulatory and normal office blood pressure. Ann Intern Med 1999; 131: 564–572.

    CAS  PubMed  Article  Google Scholar 

  17. Sega R et al. Alterations of cardiac structure in patients with isolated office, ambulatory or home hypertension. Data from the General Population (Pressione Monitorate E Loro associazioni [PAMELA] Study). Circulation 2001; 104: 1385–1392.

    CAS  PubMed  Article  Google Scholar 

  18. Strandberg TE, Salomaa V . White coat effect, blood pressure and mortality in men: prospective cohort study. Eur Heart J 2000; 21: 1714–1718.

    CAS  PubMed  Article  Google Scholar 

  19. Gustavsen PH et al. White coat hypertension is a cardiovascular risk factor: a 10-year follow-up study. J Hum Hypertens 2003; 17: 811–817.

    CAS  Article  PubMed  Google Scholar 

  20. Alderman MH et al. Blood pressure reactivity predicts myocardial infarction among treated hypertensive patients. J Clin Epidemiol 1990; 43: 859–866.

    CAS  PubMed  Article  Google Scholar 

  21. Verdecchia P et al. Ambulatory pressure: an independent predictor of prognosis in essential hypertension. Hypertension 1994; 24: 793–801.

    CAS  PubMed  Article  Google Scholar 

  22. Verdecchia P et al. Prognostic significance of the white coat effect. Hypertension 1997; 29: 1218–1224.

    CAS  PubMed  Article  Google Scholar 

  23. Celis H et al. Cardiovascular risk in white-coat and sustained hypertensive patients. Blood Press 2002; 11: 352–356.

    PubMed  Article  Google Scholar 

  24. Khattar RS, Senior R, Lahiri A . Cariovascular outcome in white-coat versus sustained mild hypertension. A 10-year follow-up study. Circulation 1998; 98: 1892–1897.

    CAS  PubMed  Article  Google Scholar 

  25. Fagard R et al. Response to antihypertensive therapy in older patients with sustained and nonsustained systolic hypertension. Circulation 2000; 102: 1139–1144.

    CAS  PubMed  Article  Google Scholar 

  26. Kario K et al. Silent and clinically overt stroke in older Japanese subjects with white-coat and sustained hypertension. J Am Coll Cardiol 2001; 38: 238–245.

    CAS  PubMed  Article  Google Scholar 

  27. Fletcher A et al. Survival of hypertensive subjects identified on screening: results for sustained and unsustained diastolic hypertension. Eur Heart J 1992; 13: 1595–1601.

    CAS  PubMed  Article  Google Scholar 

  28. Mayhew SR . Hypertension screening in General Practice. Report on behalf of the General Practitioner Hypertension Study Group. J R Coll Gen Pract 1983; 33: 434–437.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998; 17: 703–713.

  30. Kannel WB, Wilson PWF, Zhang T-J . The epidemiology of impaired glucose tolerance and hypertension. Am Heart J 1991; 121: 1268–1273.

    CAS  Article  PubMed  Google Scholar 

  31. Grodzicki T, Palmer A, Bulpitt C . Incidence of diabetes and gout in hypertensive patients. J Hum Hypertens 1997; 11: 583–585.

    CAS  PubMed  Article  Google Scholar 

  32. Higgins M et al. Hazards of obesity: the Framingham experience. Acta Med Scand 1987; 723 (Suppl): 23–36.

    Google Scholar 

  33. Stamler R et al. Weight and blood pressure. Findings in hypertension screening of one million Americans. JAMA 1978; 240: 1607–1609.

    CAS  PubMed  Article  Google Scholar 

  34. Verdecchia P et al. Independent predictors of isolated clinic (‘white-coat’) hypertension. J Hypertens 2001; 19: 1015–1020.

    CAS  PubMed  Article  Google Scholar 

  35. Wingfield D, Freeman GK, Bulpitt C . Selective recording in blood pressure readings may increase subsequent mortality. Q J Med 2002; 95: 571–577.

    CAS  Article  Google Scholar 

Download references


We acknowledge the work of the following doctors whose practices formed the GP Hypertension Study Group: I Bradley (Pontesbury), G Dyker (East Kilbride), P Ganvir (Manchester), N Gostick (Rugby), SR Mayhew (East Socon), F Shepherd (Southall), F Wells (Ipswich), L Williams (Darlington). We also thank their nursing colleagues who performed much of the clinical work of the study, the patients who participated and Ciba-Geigy for administering the initial screening program. CJB was in receipt of a grant from the Bristol Heart Foundation for this analysis.

Author information

Authors and Affiliations



Corresponding author

Correspondence to D Wingfield.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Wingfield, D., Grodzicki, T., Palmer, A. et al. Transiently elevated diastolic blood pressure is associated with a gender-dependent effect on cardiovascular risk. J Hum Hypertens 19, 347–354 (2005).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • transient hypertension
  • white-coat effect
  • cardiovascular risk

Further reading


Quick links