'White-Coat'' Hypertension
May Signal Heart Problem

NEW YORK (Reuters Health) - Blood pressure that rises only in the doctor's office--so-called ``white-coat'' hypertension--may be more serious than widely believed, according to Italian researchers.

Dr. Anna M. Grandi and colleagues at the University of Insubria in Varese report that patients with white-coat hypertension showed signs of heart damage similar to, but not as severe as, patients with chronic high blood pressure.

Currently, experts remain divided on whether white-coat hypertension, which is thought to be due to the stress of a healthcare visit, is a benign condition or a sign of heart disease that should be treated.

In this study, the researchers evaluated echocardiogram images of the heart in three groups with 42 patients in each. One group had normal blood pressure and another had chronic high blood pressure, or hypertension. Patients in the third group had white-coat hypertension--meaning their blood pressure was elevated during office visits, but normal when monitored throughout the day with an ambulatory device.

The researchers found that the walls of the left ventricle, one of the heart's upper chambers, appeared thicker in patients with white-coat hypertension, compared with those with normal blood pressure levels. They were also more likely to show left ventricular hypertrophy, an enlargement of the chamber linked to the risk of heart attack and stroke.

As expected, those with chronic high blood pressure showed the highest degree of damage to the left ventricle.

Although the study does not explain the underlying mechanism of the left-ventricle changes seen in patients with white-coat hypertension, the authors note that ``transient blood pressure increases, caused by exaggerated response to mild stress...may have an effect on cardiac growth, leading to hypertrophy.''

``The results of this study support the hypothesis that (white-coat) hypertension should not be simply considered a benign condition,'' the authors conclude.

This study does not settle the argument as to whether patients should be treated for white-coat hypertension, according to an accompanying editorial.

``But it does present data to reinforce the concept of treating patients based on in-office blood pressure (measurements),'' writes Dr. Marvin Moser of Scarsdale, New York.

``At present, with our knowledge of the benefits of lowering blood pressure and the realization that this usually does not involve complicated or dangerous regimens, it is good policy to treat white-coat hypertensives,'' Moser concludes.

Blood pressure readings are taken in two numbers. The systolic value (the first number in a blood pressure measurement) describes the pressure in the heart during contraction. The second number, the diastolic value, represents the pressure when the heart is at rest between beats.

Blood pressure readings above 140/90 mm Hg are considered high. In this study, white-coat hypertension was defined as having a systolic pressure over 140 or a diastolic pressure over 90 during doctor visits, but a regular daytime blood pressure of 130/80 or less.

SOURCE: Archives of Internal Medicine 2001:161;2677-2681.

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