White Coat Hypertension Is Not Harmless

MedicalResearch.com Interview with:
“Blood Pressure” by Bernard Goldbach is licensed under CC BY 2.0José R. Banegas, M.D.
Department of Preventive Medicine and Public Health
Universidad Autónoma de Madrid
Madrid, Spain

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Population-based studies and a few relatively small clinical investigations have defined the prognostic role of ambulatory blood pressure monitoring (ABPM) in hypertensive patients. However, previous studies were mostly limited by relatively small number of outcomes.

Our study is the largest worldwide and provides unequivocal evidence that ABPM is superior to clinic pressure at predicting total and cardiovascular mortality across a wide range of clinical scenarios – the differences are striking. Also, whether white-coat hypertension is a benign phenotype is still debated.

Our study demonstrates that white-coat hypertension was not benign. Lastly, masked hypertension patients (clinic BP normal but ABPM elevated) experienced the greatest risk of death.  

MedicalResearch.com: What should readers take away from your report?

Response: A hypertension diagnosis based exclusively on blood pressure readings in the clinic is no longer acceptable. There is no scientific or clinic justification for not using ambulatory blood pressure monitoring, which should be part of the evaluation and follow-up of most hypertensive patients.  Where ABPM is not available or affordable, home blood pressure monitoring would be an alternative. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: This is an observational study on the prognostic value of blood-pressure monitoring and, thus, no direct inference can be made regarding the benefit of basing treatment on ambulatory blood-pressure measurements. These benefits should be tested in clinical trials. Also, we studied a white population, and the results may not apply to people of other races. 

MedicalResearch.com: Is there anything else you would like to add?

Response: This study´s researchers propose that the ABPM advantages should be adequately explained to physicians and the patients, and that ambulatory blood pressure monitoring use should be extended towards universal covering. This may improve the health of patients and the sustainability of the health system due to a better diagnosis and treatment of hypertension. 


Relationship between Clinic and Ambulatory Blood-Pressure Measurements and Mortality

José R. Banegas, M.D., Luis M. Ruilope, M.D., Alejandro de la Sierra, M.D., Ernest Vinyoles, M.D., Manuel Gorostidi, M.D., Juan J. de la Cruz, M.Sc., Gema Ruiz-Hurtado, Ph.D., Julián Segura, M.D., Fernando Rodríguez-Artalejo, M.D., and Bryan Williams, M.D.

April 19, 2018
N Engl J Med 2018; 378:1509-1520
DOI: 10.1056/NEJMoa1712231  

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Last Updated on April 20, 2018 by Marie Benz MD FAAD