White-Coat Hypertension as a Risk Factor for the Development of Home Hypertension

Background: White-coat hypertensionis a condition characterized by elevated blood pressure (BP) in medical settings combined with normal ambulatoryrecorded BP or self-measured BP at home (home BP). However, it is unknown whether this condition represents a transient statein the development of hypertension outside medical settings. Methods: We followed up 128 subjects with whitecoat hypertension (home BP 135/85 mm Hg and office BP 140/90 mm Hg) for 8 years and compared the risk of progression with home hypertension (home BP 135/85 mm Hg or start of treatment with antihypertensivemedication)with649sustainednormotensivesubjects (home BP 135/85 mm Hg and office BP 140/90 mmHg)usingdatafrompopulation-basedhomeBPmeasurement projects in Japan. Results: During the 8-year follow-up period, 60 subjects (46.9%) with white-coat hypertensionand 144 (22.2%)withsustainednormotensionprogressedtohome hypertension. The odds ratio of subjects with white-coat hypertensionfor progression to home hypertension (adjusted for possible confounding factors) was significantly higherthanforsubjectswithsustainednormotension(odds ratio, 2.86;P.001). This association was observed independent of baseline home BP levels. Conclusion: The results from the present 8-year follow-up study demonstrate that white-coat hypertensionis a transitional condition to hypertension outside medicalsettings,suggestingthatwhite-coathypertensionmay carry a poor cardiovascular prognosis. Arch Intern Med. 2005;165:1541-1546