Early ReportWhite-coat hypertension as a cause of cardiovascular dysfunction
Introduction
Most clinical trials of antihypertensive treatment have relied on conventional clinic measurement of blood pressure to identify hypertensive patients and to demonstrate the benefits of blood pressure reduction.1 However, 20–40% of individuals with borderline clinic hypertension can be reclassified as normotensive during daytime ambulatory monitoring,25 and these trials inevitably included some such individuals with white-coat hypertension. However, controversy remains about the precise definition of white-coat hypertension. For example, one definition is a raised diastolic pressure (90–104 mm Hg) at clinic but normal daytime ambulatory blood pressure (below the 90th percentile of a normotensive control group)2 and another is a mean clinic blood pressure at least 6 mm Hg higher than the ambulatory mean.3 Nevertheless, the inclusion of white-coat hypertensive patients in the studies cited did not prevent the demonstration of significant reductions in cardiovascular disease. Irrespective of the definition, and despite the recognition that the presence of medical personnel influences blood pressure,6 the general assumption is that the inclusion of white-coat hypertensive patients may have diluted the overall magnitude of the benefits of a drug treatment found in previous studies. Another possibility is that the white-coat hypertensive patients also benefited from active treatment–this idea is the substance of our hypothesis. The main aim of our pilot study was the non-invasive measurement of a range of indices of cardiovascular function in patients referred for evaluation of their hypertension, to find out whether patients with white-coat hypertension differ from patients with hypertension or normotensive individuals in terms of known markers of hypertensive cardiovascular disease.
Section snippets
Methods
65 consecutive patients referred for assessment of hypertension were asked for written informed consent to take part in this study, which was approved by the local ethics committee. Eligible patients were aged 45–75 years, had no evidence of clinically significant disease (including cardiovascular or cerebrovascular disease, atrial fibrillation, or significant heart valve disease, insulin-dependent diabetes, renal impairment, or liver disease); and were not receiving antihypertensive treatment
Statistical analysis
Three groups of patients were defined on the basis of ambulatory blood pressure monitoring profiles and clinic recordings: persistently hypertensive patients who had a diastolic pressure of 95 mm Hg or more both at the clinic and on daytime ambulatory monitoring; white-coat hypertensive patients who had a diastolic pressure of 95 mm Hg or more at the clinic but not on ambulatory blood pressure monitoring; and normotensive patients who had a diastolic pressure 95 mm below Hg at all times. These
Results
There were no significant differences in sex distribution, age, weight, or height between the groups of patients (table 1). By definition, clinic blood pressures were higher in persistently and white-coat hypertensive patients than in the normotensive patients, and ambulatory blood pressure monitoring pressures were higher in persistently hypertensive patients than in either of the other groups (figure 1). There were no significant differences in heart rate or pulse pressure between groups.
Discussion
Our main finding was that similar abnormalities of cardiovascular function–including reduced arterial elasticity and left ventricular diastolic dysfunction–occur in patients with white-coat hypertension and those with persistent hypertension.
Both the persistently and white-coat hypertensive patients had larger arteries than the normotensive patients, as has been previously described.11 Although these differences might simply reflect higher blood pressures at the time of the ultrasonographic
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Cuffless blood pressure estimation from PPG signals and its derivatives using deep learning models
2021, Biomedical Signal Processing and ControlCitation Excerpt :However, despite this advantage, cuff-based BP measurement is mostly intermittent, tedious, and inconvenient. Moreover, it may result in inaccurate BP values, which can lead to misdiagnosis, such as the “masked hypertension” [7] or the “white coat hypertension” [8]. The former scenario occurs when a normal BP is observed for a patient when their actual BP is high, as opposed to the latter where high BP is observed for a nervous or anxious patient with actually a normal BP.
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