Long-term changes in clinic blood pressure in patients with white-coat hypertension

Background. White-coat hypertension, defined as hypertensive blood pressure values in a clinical setting but normal self-measured blood pressures, is relatively common among young patients but long-term spontaneous changes in clinic blood pressure in these patients with white-coat hypertension have not been assessed. Design. A prospective study, with two clinical examinations (with a 5-year interval between the examinations). Methods. We examined 188 male patients (mean age 16 years) with clinic blood pressures > 140/90 mmHg at baseline by determining clinic and home blood pressures, heart rates, heights and weights. These parameters were re-examined 5 years later. White-coat hypertension (n = 139) was defined as an average home blood pressure < 130/90 mmHg. Results. A decrease in clinic systolic blood pressure to < 140 mmHg during the 5-year follow-up was observed in 101 of the 139 patients with white-coat hypertension (73%) and 26 of the 49 patients with sustained hypertension (53%, P < 0.02). There was no difference between clinic heart rates and body mass indices at baseline of the patients who remained hypertensive in the clinic and those who became normotensive. Both the white-coat and the sustained hypertensive patients who remained hypertensive had higher baseline home blood pressures and an increase in body mass index during the 5-year period and maintained the baseline clinic heart rate, whereas those who became normotensive exhibited a reduction in clinic heart rate and maintained the baseline body mass index. The clinic systolic blood pressure at 5-year follow-up was correlated significantly to the clinic and home systolic blood pressures at baseline, the heart rate and body mass index at 5-year follow-up and the changes in body mass index during the 5-year period. Conclusions. The prevalence of clinic systolic blood pressures < 140 mmHg during the 5-year period among patients with white-coat hypertension was higher than that among those with sustained hypertension. The clinic and home blood pressures at baseline and body mass indices and clinic heart rates at 5-year follow-up were related to the clinic systolic blood pressures at 5-year follow-up. These results suggest that control of body weight is important in the management both of young patients with white-coat hypertension and of those with sustained hypertension.