White Coat Hypertension Is Associated with a Greater All-cause Mortality

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Background: Prognostic significance of white coat hypertension (WCH) remains controversial and most of the studies have just focused on the progression to hypertension (HT) or whether or not it already causes target organ damage. Methods: We studied consecutive adults and eldelies with sustained normotension (NT), WCH, and HT applying to the Internal Medicine Polyclinic. A 10 day twice daily measurement of blood pressure at home (HBP) was obtained in all cases, and a 24 hr ambulatory blood pressure monitoring (ABPM) was performed just for the cases with higher office and/or HBP measurements. Prevalences of smoking, overweight, obesity, impaired glucose tolerance, type II diabetes mellitus, hyperbetalipoproteinemia, hypertriglyceridemia, and dyslipidemia were calculated in each group and results were compared in between. Comparison of proportions was used as the statistical analysis method. Results: The study totally included 169 cases, 54 with sustained NT, 66 with WCH, and 49 with HT. The 115 patients with WCH and HT were both diagnosed via HBP and ABPM, and no difference was observed between the two methods for the diagnosis of WCH and masked or obvious HT. Except the smoking and overweight, almost all of the above disorders showed a stepwise and significant progression in frequencies from sustained NT toward WCH and HT. Conclusions: WCH should preferentially be accepted as a disorder associated with a greater all-cause mortality, rather than a predisposing factor of HT or atherosclerosis alone, and its management should be focused on the above comorbid disorders.