Estimate of white-coat effect and arterial stiffness
- 1 April 2007
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Hypertension
- Vol. 25 (4), 827-831
- https://doi.org/10.1097/hjh.0b013e32801d1f62
Abstract
Blood pressure (BP) measured in the office is usually higher than the average ambulatory BP, a difference generally taken as an estimate of the white-coat effect. This study was designed to assess whether such a difference is associated with impairment of the conduit arterial system. We calculated the difference between office and average daytime peak systolic blood pressure (DeltaSBP) in 2778 hypertensive participants (1240 women) of the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale cohort. Arterial stiffness was evaluated using an adjusted office pulse pressure to stroke volume ratio (PP/SV), measured at rest, which has previously been shown to predict cardiovascular outcome independent of echocardiographic left ventricular hypertrophy. Effective arterial elastance was also estimated. Across quintiles of PP/SV, significant linear, positive trends were found with age, the proportion of women, plasma glucose and triglyceride levels (0.05 > P < 0.0001). Heart rate measured in the office increased mildly with quintiles of PP/SV (P < 0.05). After adjusting for age, sex, body weight and office heart rate, DeltaSBP progressively increased with increasing quintiles of PP/SV (P for trend < 0.0001), whereas stroke volume decreased, paralleling the increase in left ventricular relative wall thickness (both P < 0.0001) and left ventricular mass index (P < 0.05). The significant increase in effective arterial elastance with quintiles of PP/SV was also independent of peak systolic BP, in addition to age, sex, heart rate and body weight. The difference between office BP and ambulatory BP, an estimate of the white-coat effect, is strongly associated with increased arterial stiffness, evaluated by a two-element fluid system accumulator.This publication has 35 references indexed in Scilit:
- Risk Factors for Arterial Hypertension in Adults With Initial Optimal Blood PressureHypertension, 2006
- Can We Afford Crude Estimates of Central Pulse Pressure?Hypertension, 2005
- Is High Pulse Pressure a Marker of Preclinical Cardiovascular Disease?Hypertension, 2005
- White-coat hypertension: a clinical reviewEuropean Journal of Internal Medicine, 2004
- Estimation of left ventricular chamber and stroke volume by limited M-mode echocardiography and validation by two-dimensional and doppler echocardiographyThe American Journal of Cardiology, 1996
- Prognostic value of left ventricular mass and geometry in systemic hypertension with left ventricular hypertrophyThe American Journal of Cardiology, 1996
- Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension.Hypertension, 1994
- “White Coat” Hypertension and Alerting Reaction in Elderly and Very Elderly Hypertensive PatientsBlood Pressure, 1993
- Variability between current definitions of 'normal' ambulatory blood pressure. Implications in the assessment of white coat hypertension.Hypertension, 1992
- Arterial baroreflexes and blood pressure and heart rate variabilities in humans.Hypertension, 1986