Journal of the American Society of Hypertension
Epidemiology/Special PopulationsRisk of mortality and cardiovascular events in white coat hypertension: a systematic review and meta-analysis
Section snippets
Background
White coat hypertension (WCH) is defined as a high office blood pressure but normal out-of-office blood pressure. There is evidence that WCH can lead to sustained hypertension, requiring treatment. However, the risk of WCH on mortality or cardiovascular events is still unclear. We performed a systematic review and meta-analysis on the incidence of all-cause mortality and cardiovascular events in white coat hypertension comparing to true normotension.
Methods
We comprehensively searched in databases of MEDLINE and EMBASE from their inception to December 2015. We used search terms including “white coat hypertension”, “ambulatory blood pressure”, “office blood pressure”, “mortality”, “cardiovascular disease”, and “cardiovascular events”. Inclusion criteria were published prospective observational studies that compared incidence of all-cause mortality or cardiovascular events between white coat hypertension and normal blood pressure. We calculated
Results
Initial search revealed 253 full-text articles. Data was extracted from eleven prospective observational studies. Five studies were included in the meta-analysis of all-cause mortality. There was a significant increase incidence of mortality in WCH with pooled HR of 1.51 (95% CI 1.27 - 2.02, p=0.006). Six studies were included in the meta-analysis of cardiovascular events. There was no difference in incidence of cardiovascular events in WCH with pooled HR of 0.97 (95% CI 0.73 - 1.28, p=0.82)
Conclusions
Incidence of all-cause mortality is higher in patients with white coat hypertension, although there is no difference in cardiovascular events risk. Future interventional studies should assess mortality benefits by treating white coat hypertension.
Keywords
White coat hypertension; mortality; cardiovascular risk; meta-analysis