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. 2025 Nov 17;38(12):1043-1050.
doi: 10.1093/ajh/hpaf136.

Prognostic Impact of Different Definitions of White-Coat Hypertension

Paolo Verdecchia  1 , Stefano Coiro  2 , Claudia Bartolini  2 , Adolfo Aita  3 , Claudia Borgioni  3 , Salvatore Repaci  3 , Chiara Dembech  4 , Massimo Guerrieri  4 , Nicola Sacchi  4 , Sergio Bistoni  5 , Mario Trottini  5 , Fabio Angeli  6   7
Affiliations

Prognostic Impact of Different Definitions of White-Coat Hypertension

Paolo Verdecchia et al. Am J Hypertens. .

Abstract

Background: Different definitions of white-coat hypertension (WCH) may explain its variable outcome across studies.

Methods: In an Italian study started in 1986, we followed 3,153 people with (office blood pressure (BP) >=140/90 mmHg) and 457 without office hypertension for a mean of 10.4 years. None had previous cardiovascular disease. All underwent 24-h ambulatory BP (ABP) monitoring. We defined white-coat hypertension (WCH) as an average 24-h ABP < 130/80 mmHg or <125/75 mmHg. The primary outcome was a composite of major adverse cardiovascular events (MACE) and all-cause mortality.

Results: Baseline office BP was 156/97 mmHg in people with and 127/81 mmHg without hypertension. At follow-up, MACE events were 344 and 23, and all-cause deaths were 318 and 24 in people with and without hypertension, respectively. Compared to normotensive group, MACE risk was not higher in people with WCH and 24-h ABP < 125/75 mmHg (hazard ratio (HR), 0.94; 95% confidence interval (CI), 0.42-2.10). Compared to normotensive group, MACE risk was higher in people with WCH and 24-h ABP < 130/80 mmHg (HR: 1.79; 95% CI, 1.07-2.29). All-cause death did not differ between the normotensive group and people with WCH and 24-h ABP < 125/75 mmHg (HR 1.37; 95% CI, 0.68-2.73), but it was higher than in the normotensive group when WCH was defined by a 24-h ABP < 130/80 mmHg (HR 1.82; 95% CI, 1.55-3.58).

Conclusions: WCH defined by an average 24-h ABP < 125/75 mmHg identifies people at low risk of MACE and death in the long term. Even modestly above these threshold values, the risk associated with WCH increases.

Keywords: ambulatory blood pressure monitoring; blood pressure; cardiovascular death; heart failure; hypertension; myocardial infarction; stroke; white-coat hypertension.

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Conflict of interest statement

The authors declared no conflict of interest.

Figures

None
Prognostic impact of different guideline-suggested definitions of white-coat hypertension.
Figure 1.
Figure 1.
Flow diagram of the study.
Figure 2.
Figure 2.
Major adverse cardiovascular events.
Figure 3.
Figure 3.
All-cause death.
See this image and copyright information in PMC

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