Palatini P, Mormino P, Canali C, Baccillieri S, Giovinazzo P, Graniero GR, De Toni R, Cignacco C, et
Target organ damage in subjects with white-coat and sustained hypertension: an insight from the HARVEST study
12th Annual ASH Meeting
Am J Hypertens (Apr) 10:204A 1997

One of the more contentious areas of ambulatory blood pressure monitoring is its use to detect so called "white-coat or isolated office" hypertension. Much of the confusion has been because of the variability of definitions of what is white coat hypertension and the lack of knowledge on the evolution of subjects with this phenomenon. It is clear however that it is essential to keep the category of these subjects to be entirely normotensive on ambulatory monitoring and only office blood pressure should be elevated.

The HARVEST study studied 909 young stage 1 hypertensives, many of which had echocardiography and microalbumin measurements. The authors used two different criteria for white coat hypertension (WCH); mean daytime BP < 135/85 mmHg and < 140/90 mmHg. Indices of microalbumin excretion rate (AER) and left ventricular mass were corrected for office BP. 

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* p < .05 vs WCH
                             AER (mg/d)          LV mass index (g/m2)

                             WCH       EH             WCH       EH

Criterion < 135/85        8.8       13.7*          89         94*

Criterion < 140/90        9.5       15.7*          91         95*
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It is clear that irrespective of office BP, the subjects with higher ambulatory BP have higher hypertensive disease markers.

Comment: This study points out clearly that ambulatory BP is the potent correlate of microalbuminuria and left ventricular mass in young subjects. Therefore the cut off of 140/90 on daytime ambulatory BP should not be used to separate hypertensives from white coat hypertensives. (George Mansoor, M.D., University of Connecticut)

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12th Annual ASH Meeting
H: Exam and lab tests : White coat hypertension
H: Pathophysiology : Heart in hypertension