Spontaneous evolution of white-coat hypertension.

To assess the spontaneous evolution of white-coat hypertension (WCH) over time, 64 hypertensive patients with WCH [clinic BP ≥ mmHg and daytime ambulatory BP (ABP) < mmHg in women and < mmHg in men] underwent ABP and echocardiography (M-mode and Doppler) initially and after 0.5-8.2 years (mean, 2.7), in the absence of therapy. Those with normal ABP also at follow-up (WCH → WCH) were compared with those who developed ambulatory hypertension (WCH → AH). In the WCH → WCH group (72% of subjects), age at entry was 46.1 years and women were 59%. Clinic BP and 24-hour ABP changed from to mmHg and from to mmHg, left ventricular mass (LVM) from 93 to 91 g/m2, peakA/peakE ratio from 0.90 to 0.91 and body weight from 74.3 to 74.4. Kg (all comparisons: P=n.s.). In the WCH → AH group (28%), age at entry was 39.6 years and women were 33%. Clinic BP and 24-hour ABP changed from to mmHg (p=n.s.) and from to mmHg (both p<0.01), LVM from 98 to 102 g/m2 (p=n.s.), peakA/peakE ratio from 0.74 to 0.95 (p=0.02) and body weight from 76.1 to 77.4 Kg (p=n.s.). In a logistic regression model, only age (p=0.021) and average 24-h diastolid BP (p=0.007) showed an association with outcome. The changes in LVM differed between the WCH → WCH group (+1.6%) and the WCH → AH group (+5.9%) [p=0.038], as well as the changes in the peakA/peakE ratio (+6.4% vs +27.3%, P=0.038). The changes in LVM paralleled those in the average 24-h systolic and diastolic ABP (r=0.39 and 0.27, p<0.05), but not those in clinic BP (r=0.03 and 0.10). In conclusion, 28% of subjects with WCH spontaneously developed AH after 0.5-8.2 years. In these subject, but not in those who remained in the WCH category, LV mass increased over time with increasing ABP, and early diastolic relaxation worsened. Clinic BP was completely useless to predict outcome. The WCH → WCH subjects tended to be more frequently women and were recognizable at entry by lower ABP levels and older age.