White-coat hypertension as a risk factor for the development of home hypertension: the Ohasama study

Arch Intern Med. 2005 Jul 11;165(13):1541-6. doi: 10.1001/archinte.165.13.1541.


Background: White-coat hypertension is a condition characterized by elevated blood pressure (BP) in medical settings combined with normal ambulatory-recorded BP or self-measured BP at home (home BP). However, it is unknown whether this condition represents a transient state in the development of hypertension outside medical settings.

Methods: We followed up 128 subjects with white-coat hypertension (home BP <135/85 mm Hg and office BP > or = 140/90 mm Hg) for 8 years and compared the risk of progression with home hypertension (home BP > or = 135/85 mm Hg or start of treatment with antihypertensive medication) with 649 sustained normotensive subjects (home BP <135/85 mm Hg and office BP <140/90 mm Hg) using data from population-based home BP measurement projects in Japan.

Results: During the 8-year follow-up period, 60 subjects (46.9%) with white-coat hypertension and 144 (22.2%) with sustained normotension progressed to home hypertension. The odds ratio of subjects with white-coat hypertension for progression to home hypertension (adjusted for possible confounding factors) was significantly higher than for subjects with sustained normotension (odds ratio, 2.86; P<.001). This association was observed independent of baseline home BP levels.

Conclusion: The results from the present 8-year follow-up study demonstrate that white-coat hypertension is a transitional condition to hypertension outside medical settings, suggesting that white-coat hypertension may carry a poor cardiovascular prognosis.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Blood Pressure / physiology*
  • Blood Pressure Monitoring, Ambulatory
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension / epidemiology
  • Hypertension / etiology*
  • Hypertension / physiopathology
  • Incidence
  • Japan / epidemiology
  • Male
  • Middle Aged
  • Risk Factors
  • Severity of Illness Index