New research suggests that “white coat” hypertension and “masked” hypertension are associated with an increase in heart and vascular disease. Findings from the study are published in the Journal of the American College of Cardiology

White coat hypertension refers to blood pressure that is high in a medical setting but normal at home. Many healthcare professionals have viewed it as a benign condition but Dr. Wanpen Vongpatanasin, professor at UT Southwestern, and colleagues report otherwise. 

Masked hypertension, the opposite of white coat hypertension, refers to normal blood pressure in a medical setting but high readings at home. 

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Researchers examined data from study subjects in the Dallas Heart Study, a longitudinal, multi-ethnic, population-based study. White coat hypertension was seen in 3% of subjects and masked hypertension was seen in 18%. 

Each subject’s urine albumin-to-creatinine ratio (UACR) and cystatin C levels were measured as well as the stiffness of his/her aorta. Patients were followed for 9 years to track cardiovascular events, including heart attack, stroke, heart failure, atrial fibrillation, heart bypass surgery, angina, and cardiac catheterization procedures. 

Findings showed that white coat and masked hypertension were linked to an increase in cardiovascular events over time even with adjusting for traditional risk factors (eg, diabetes). In addition, both types of hypertension were tied to an increased incidence of organ damage such as aortic stiffness and kidney damage. 

“These findings have important implications, and suggest that monitoring only in the physician’s office may not tell the full story about blood pressure and blood pressure control,” said Dr. James de Lemos, Professor of Internal Medicine at UT Southwestern and a contributor to the study. “Monitoring blood pressure in the home setting appears to identify a substantial number of individuals at risk for the long-term effects of hypertension who would have been missed had only the clinic blood pressure been considered.”

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