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Reverse white-coat effect as an independent risk for left ventricular concentric hypertrophy in patients with treated essential hypertension

Abstract

Recent studies have shown that the converse phenomenon of white-coat hypertension called ‘reverse white-coat hypertension' or ‘masked hypertension' is associated with poor cardiovascular prognosis. We assessed the hypothesis that this phenomenon may specifically influence left ventricular (LV) structure in treated hypertensive patients. A total of 272 outpatients (mean age, 65 years) with chronically treated essential hypertension and without remarkable white-coat effect were enrolled. Patients were classified into two groups according to office and daytime ambulatory systolic blood pressure (SBP); that is subjects without (Group 1: office SBP daytime SBP, n=149) and with reverse white-coat effect (Group 2: office SBP<daytime SBP, n=123). LV mass index and relative wall thickness were echocardiographically determined. In all subjects, LV mass index and relative wall thickness were positively correlated with daytime and 24-h SBP, but not with office SBP. In addition, these two indices were inversely correlated with office – daytime SBP difference. LV mass index (136±31 and 115±28 g/m2, mean±s.d.) and relative wall thickness (0.49±0.09 and 0.46±0.07) were significantly greater in Group 2 than in Group 1. As for LV geometric patterns, Group 2 had a significantly higher rate of concentric hypertrophy compared with Group 1 (48 and 28%). Multivariate analyses revealed that the presence of reverse white-coat effect was a predictor for LV concentric hypertrophy, independent of age, sex, hypertension duration, antihypertensive treatment and ambulatory blood pressure levels. Our findings demonstrate that reverse white-coat effect is an independent risk factor for LV hypertrophy, especially concentric hypertrophy, in treated hypertensive patients.

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Acknowledgements

This study was supported by the Grant for Cardiovascular Disease (11C-5) and the Health and Labor Sciences Research Grants (H14-kouka-021) from the Ministry of Health, Labor and Welfare of Japan, and the Grant from Japan Cardiovascular Research Foundation. We thank Chikako Tokudome, Yoko Oikawa, Yoko Saito, and Miho Nishibata for their secretarial assistance.

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Tomiyama, M., Horio, T., Kamide, K. et al. Reverse white-coat effect as an independent risk for left ventricular concentric hypertrophy in patients with treated essential hypertension. J Hum Hypertens 21, 212–219 (2007). https://doi.org/10.1038/sj.jhh.1002127

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