White-coat hypertension and cardiovascular events: a meta-analysis

J Hypertens. 2016 Apr;34(4):593-9. doi: 10.1097/HJH.0000000000000832.


Background: White-coat hypertension (WCH) is a frequent condition particularly in children and elderly individuals. The prognostic significance of WCH is still a matter of debate.

Methods: The present study was designed to systematically review cohort studies and assess the effects of WCH compared with normotension and sustained HTN on cardiovascular events and death, stroke, and all-cause mortality. We systematically searched the electronic databases, MEDLINE, PUBMED, EMBASE, and Cochrane for prospective cohort studies, which evaluated participants with office, and ambulatory, and/or home blood pressure.

Results: We included 14 studies with a total number of 29 100 participants (13 538 normotensive patients, 4806 with WCH and 10 756 with sustained HTN) with mean age of 59 years and follow-up of 8 years. Individuals with WCH had higher rates of cardiovascular disease morbidity and mortality but not significantly different all-cause mortality and stroke risk compared with normotensive patients. Cardiovascular disease morbidity and mortality, all-cause mortality, and stroke rates were significantly increased in patients with sustained HTN compared with WCH.

Conclusion: The cardiovascular morbidity and mortality associated with WCH may be slightly higher compared with normotension but well below the risks associated with sustained HTN.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Aged
  • Cardiovascular Diseases* / complications
  • Cardiovascular Diseases* / epidemiology
  • Humans
  • Middle Aged
  • White Coat Hypertension* / complications
  • White Coat Hypertension* / epidemiology