HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) In Brief Journal Club TRACK Discussion: Submit a Comment Alert me when this article is cited Alert me when TRACK Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Download to citation manager Citing Articles Citing Articles via HighWire Google Scholar Articles by Dawes, M. G. Articles by Juszczak, E. PubMed PubMed Citation Articles by Dawes, M. G. Articles by Juszczak, E.

Comparing the Effects of White Coat Hypertension and Sustained Hypertension on Mortality in a UK Primary Care Setting

¹ Department of Family Medicine, McGill University, Montreal, Quebec, Canada
² Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
³ Centre for Statistics in Medicine, University of Oxford, Oxford, England, United Kingdom

CORRESPONDING AUTHOR: Martin G. Dawes, MBBS, PhD, Department of Family Medicine, McGill University, 515 to 517, Pine Ave W, Montreal, QC, H2W 1S4, Canada, martin.dawes{at}mcgill.ca

Annals Journal Club selection—see inside back cover or http://www.annfammed.org/AJC/.

PURPOSE We examined all-cause mortality within a primary care setting in patients with white coat hypertension or sustained hypertension in whom blood pressure (BP) monitoring was indicated.

METHODS This prospective multicenter study of ambulatory BP monitoring included 48 family practices in the county of Oxfordshire, United Kingdom. Mortality was compared for patients having white coat hypertension (mean of 3 clinic BP readings >140/90 mm Hg and daytime ambulatory readings =135/85 mm Hg) and patients having sustained hypertension (mean of 3 clinic readings >140/90 mm Hg and daytime ambulatory readings >135/85 mm Hg).

RESULTS A routine primary care cohort consisting of 5,182 patients chosen to undergo ambulatory BP monitoring by their family physician was followed up for a median of 7.3 years (interquartile range, 5.8–8.9). There were 335 deaths (6.5%), corresponding to a mortality rate of 8.9 deaths (95% confidence interval [CI], 8.0–9.9) per 1,000 years of follow-up. Patients with white coat hypertension (n = 1,117) were more likely to be female and were on average younger than patients with sustained hypertension (n = 4,065). The unadjusted rate of all-cause mortality in patients with white coat hypertension was lower, at 4.4 deaths per 1,000 years of follow-up (95% CI, 3.1–6.0) than that in patients with sustained hypertension, at 10.2 deaths per 1,000 years of follow-up (95% CI, 9.1–11.4). This reduction in all-cause mortality was still clinically significant after adjustment for age, sex, smoking, use of antihypertensive medication, and practice-clustering effects (hazard ratio = 0.64; 95% CI, 0.42–0.97; P=.04).

CONCLUSIONS White coat hypertension (elevation of clinic BP only) confers significantly less risk of death than sustained hypertension (elevation of both clinic and ambulatory BPs). Trials are now needed to evaluate the risk reduction achievable in patients who have white coat hypertension and are receiving BP-lowering therapy.

Key Words: Hypertension • white coat • mortality • primary care • family practice • ambulatory monitoring • blood pressure • practice-based research

This article has been cited by other articles:

				K. C. Stange In this Issue: Access to Care, Spirituality, and Relevant Research Ann. Fam. Med, September 1, 2008; 6(5): 386 - 387. [Full Text] [PDF]