LEFT-VENTRICULAR MASS AND GEOMETRY IN PATIENTS WITH ESTABLISHED HYPERTENSION AND WHITE COAT HYPERTENSION

This study was designed to compare the cardiac mass and geometry in wh ite coat hypertensive patients and established hypertensive patients t hrough the prospective comparison of office blood pressure, daytime am bulatory blood pressure, and echocardiographically determined left ven tricular mass and cardiac geometry in consecutive patients. We studied 143 patients from general practice in an outpatient hypertension unit . The patients had newly diagnosed mild-to-moderate hypertension prior to the institution of pharmacological antihypertensive therapy. All p atients had a diastolic office blood pressure above 90 mm Hg; 90 had a consistently elevated diastolic blood pressure (established hypertens ion), whereas 53 had an average daytime ambulatory blood pressure belo w 90 mm Hg (white coat hypertension). Left ventricular mass index was significantly higher in the group with established hypertension, 102.4 +/- 26.6 g/m2 (mean +/- SD) v 93.6 +/- 23.5 (P = .045). Relative wall thickness was likewise significantly higher, 0.36 +/-0.07 v 0.33 +/- 0.06 (P = .004). There was no significant difference in left atrial di mension, In a multiple regression model the ambulatory measurements an d not the office measurements were statistically significantly associa ted with the extent of cardiac hypertrophy. Further, 44/53 (83%) of th e patients with white coat hypertension had normal left ventricular di mensions, versus only 55/90 (61%) of the patients with established hyp ertension (P = .033). Thus, white coat hypertensive patients display l ess cardiac involvement than patients with established hypertension, i ndicating that they should rather be treated as normotensives than as hypertensives, ie, not with pharmacological antihypertensive therapy.