F. Veglio et al., Ambulatory blood pressure monitoring and clinical characteristics of the true and white-coat resistant hypertension, CLIN EXP HY, 23(3), 2001, pp. 203-211
The resistant hypertension has been differentiated in true resistant hypert
ension and white-coat resistant hypertension by using ambulatory blood pres
sure monitoring. White-coat resistant hypertension was defined as high clin
ic blood pressure, despite triple treatment for at least 3 months, but day-
time blood pressure values < 135/85 mmHg. The aim of this study was to eval
uate the presence of different clinical characteristics between two types o
f resistant hypertension.
The study group consisted of 49 patients with essential hypertension, resis
tant to an adequate and appropriate triple-drug therapy, that included a di
uretic, with all 3 drugs prescribed in near maximal doses and that had pers
istently elevated clinic blood pressure (> 140/90 mm Hg), for at least 3 mo
nths. They represented the 2% of 2500 hypertensive outpatients that referre
d at our Hypertension Unit. Patients with white-coat resistant hypertension
(n=19) were older (p <0.05) than those with true resistant hypertension (n
=30). The sodium intake (p <0.05) and alcohol intake (p <0.05) were signifi
cantly higher in patients with true resistant hypertension than in those wi
th white-coat resistant hypertension. The renin plasma activity and plasma
aldosterone were higher (p <0.05) in patients with true resistant hypertens
ion than in those with white-coat resistant hypertension with normal plasma
electrolyte balance. There were no significant differences in mean values
of office systolic and diastolic blood pressures between white coat resista
nt hypertensives and true resistant hypertensives ( 165+17 vs 172+28 and 98
+12 vs 102+14 mmHg).
Day-time and night-time ambulatory 24-h-systolic and diastolic blood pressu
res were significantly higher in the true resistant hypertensive patients w
hen compared with white-coat resistant hypertensives (153+15 vs 124+10 mmHg
and 97+9 vs 76+6 mmHg all p <0.001). Day-time and night-time ambulatory 24
-h-heart rate were significantly higher in the true resistant hypertensive
patients when compared with white-coat resistant hypertensives (79+11 vs 71
+9 beats/min ;p <0.01; 68+9 vs 60+6 beats/min. p <0.001). The ABP readings
were analysed by a Fourier series with 4 harmonics. According to the runs t
est both two groups of patients showed a circadian rhythm for both systolic
and diastolic blood pressure. The nocturnal fall in SEP, DBP and HR was no
t different in both groups of patients.
In conclusion, our findings showed that true resistant hypertensive patient
s were characterized both by higher heart rate and higher plasma renin acti
vity values as an expression of a possible increased sympathetic activity.
Thus, the combination of ABPM with the assessment of the clinical character
istics allow to differentiate better the true drug-resistant hypertension f
rom the white coat resistant hypertension.