Vasileios-Arsenios Lioutas, MD

White-coat hypertension (WCHT) is often considered a benign phenomenon, a temporary reaction of the patient’s sympathetic nervous system to the stress-provoking environment of a hospital or doctor’s office. The investigators in this cross-sectional population-based study in Japan sought to shed light in the association of WCHT and cardiovascular disease, using carotid artery metrics (intima-media thickness and stenosis by ECST criteria) as markers.

Despite methodological shortcomings and limitations due to design, the data presented imply that WCHT is not as innocent as commonly thought. In fact, patients with WCHT were found to be older and significantly more likely to have “traditional” cardiovascular risk factors, such as diabetes and hyperlipidemia, when compared to patients with normotension. More interestingly, there is a significant difference in the percentage of carotid stenosis and in absolute measurements of mean and maximum intima-media thickness between normotensive patients and those with WCHT, with the latter showing evidence of carotid atherosclerosis much more frequently- more precisely, the age- and sex-adjusted OR (95%CI) is 2.45.

By all means, the age, risk factor and carotid artery markers profile of patients with WCHT is very similar to those with masked and sustained hypertension and differs significantly from healthier adults with normal blood pressure. Although the cross-sectional design of the study doesn’t allow causative associations, this study’s findings seem to defy the notion that white coat hypertension is benign.