White-coat hypertension/effect is associated with higher arterial stiffness and stroke events

摘要

Objectives: The risk profile of white-coat hypertension/effect (WCH/E) remains unclear. This study aimed to investigate the relationship between WCH/E, markers of cardiovascular risk and cerebrovascular events. Methods: This is a sub-group analysis of The Arterial Stiffness In lacunar Stroke and Transient ischemic attack (ASIST) study, which recruited 96 patients aged at least 40 years old with a diagnosis of transient ischemic attack or lacunar stroke in the preceding 14 days. Thirty-two patients with target blood pressure (clinic blood pressure = 140/90 mmHg and daytime ambulatory blood pressure <135/85 mmHg) were included in the analysis. Results: Patients with WCH/E were older and had a higher BMI. Central SBP (145 +/- 13 vs. 118 +/- 8 mmHg, P < 0.001) and DBP (82 +/- 8 vs. 76 +/- 7 mmHg, P = 0.004) were higher in those with WCH/E. They also had higher arterial stiffness measured by carotid-femoral pulse wave velocity (11.9 +/- 3.0 vs. 9.6 +/- 2.3 m/s, P = 0.002) and cardio-ankle vascular index (10.3 +/- 1.3 vs. 9.4 +/- 1.7, P = 0.027). Regression analysis showed an independent relationship between WCH/E and both measures of arterial stiffness. Lacunar strokes were more prevalent in those with WCH/E (47 vs. 22, P = 0.039) and individuals in this group were more likely to have had a lacunar stroke than a transient ischemic attack (odds ratio 9.6, 95 CI 1.5-62.6, P = 0.02). Conclusion: In this cohort of patients with lacunar stroke and transient ischemic attack, WCH/E was associated with elevated markers of cardiovascular risk and a higher prevalence of lacunar stroke. These results suggest that WCH/E is associated with adverse cardiovascular risk.