Document Detail

Attenuation of the "white-coat effect" by antihypertensive treatment and regression of target organ damage.
MedLine Citation:
PMID:  10679506     Owner:  NLM     Status:  MEDLINE    
This study assessed whether 2 common surrogate measures of the "white-coat effect," namely the clinic-daytime and the clinic-home differences in blood pressure (BP), were attenuated by long-term antihypertensive treatment and whether this attenuation is relevant to the treatment-induced regression of left ventricular hypertrophy, thus having clinical significance. We considered data from 206 patients with essential hypertension (aged 20 to 65 years) who had a diastolic BP between 95 and 115 mm Hg and echocardiographic evidence of left ventricular hypertrophy. In each patient, clinic BP, 24-hour ambulatory BP, and left ventricular mass index were assessed at baseline, after 3 and 12 months of treatment with an angiotensin-converting enzyme inhibitor, and after a final 4-week placebo run-off period. At baseline, the clinic-daytime differences in systolic and diastolic BP were 12.1+/-15.4 and 6.8+/-10.1 mm Hg, respectively; the corresponding values for the clinic-home differences were 5.7+/-10.6 and 2.9+/-6.1 mm Hg, respectively. These differences were reduced by 57.6% and 77.1% (P<0.01) and by 65.7% and 64.3% (P<0.01), respectively, after 12 months of treatment, with a partial return toward the pretreatment differences after the final placebo period. The observed treatment-induced reductions in left ventricular mass index and those in the clinic-daytime or clinic-home differences for systolic and diastolic BP showed no significant relationship when tested by multiple regression analysis. This provides the first longitudinal evidence that clinic-daytime and clinic-home differences in BP have no substantial value in predicting the regression of target organ damage, such as left ventricular hypertrophy, that has prognostic relevance.
G Parati; L Ulian; L Sampieri; P Palatini; A Villani; A Vanasia; G Mancia
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study    
Journal Detail:
Title:  Hypertension     Volume:  35     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2000 Feb 
Date Detail:
Created Date:  2000-03-02     Completed Date:  2000-03-02     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  614-20     Citation Subset:  IM    
Clinica Medica, University of Milano-Bicocca and Ospedale S. Gerardo, Monza, Italy.
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MeSH Terms
Antihypertensive Agents / therapeutic use*
Blood Pressure / drug effects*,  physiology
Blood Pressure Determination
Blood Pressure Monitoring, Ambulatory
Hypertension / drug therapy*,  physiopathology
Hypertrophy, Left Ventricular / pathology,  prevention & control*
Middle Aged
Office Visits
Prospective Studies
Regression Analysis
Severity of Illness Index
Single-Blind Method
Time Factors
Reg. No./Substance:
0/Antihypertensive Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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