CARDIAC AND CAROTID STRUCTURE IN PATIENTS WITH ESTABLISHED HYPERTENSION AND WHITE-COAT HYPERTENSION

Aim: The introduction of ambulatory blood pressure monitoring in the c linical practice has defined a new subgroup of hypertensive patients c alled white-coat hypertensives. it has been reported that white-coat h ypertensives have less cardiac involvement than established hypertensi ve patients. This study was designed to examine the extent of cardiac and vascular involvement in patients with white-coat hypertension and established hypertension. Patients and methods: We studied 82 patients with mild essential hypertension, never previously treated, using 24- h ambulatory blood pressure monitoring and an echocardiographic and va scular ultrasonographic study. Left ventricular dimensions and mass we re obtained according to the Penn convention. The intima-media thickne ss of the posterior wall of bath common carotid arteries was measured 5, 10 and 20 mm caudally to the flow-divider and the average value was used for analysis. Results: Of the 82 patients, 31 (mean+/-SD age 35/-10 years) had average 24-h systolic/diastolic blood pressure values of below 132/85 mmHg (white-coat hypertensives) and 51 (aged 42+/-2 ye ars) had a consistently elevated diastolic blood pressure. Both groups had similar body surface area (1.82+/-0.22 versus 1.81+/-0.22 m(2)), sex distribution (20 males and 11 females versus 32 males and 19 femal es), duration of hypertension, metabolic parameters and smoking habit. The 24-h ambulatory blood pressure monitoring values were, by definit ion, significantly higher in established hypertensives than in white-c oat hypertensives (142+/-10/94+/-6 versus 127+/-6/79+/-4 mmHg, P<0.001 ). The left ventricular mass index and intima-media thickness were sig nificantly higher in the established hypertensives (112+/-17 g/m(2), 0 .67+/-0.11 mm, respectively) than in the white-coat hypertensives (98/-18 g/m(2), 0.58+/-0.09 mm; P<0.001 for both). Conclusions: The preva lence of left ventricular hypertrophy and cardiac remodeling was signi ficantly more frequent in established hypertensives (51%) compared to white-coat hypertensives (19%). These confirm that structural changes in the left ventricle in white-coat hypertensives are more limited tha n in established hypertensives and show that in white-coat hypertensiv es there is significantly less involvement of the conductance vessels than in established hypertensives.