Office white-coat effect tail and long-term cardiovascular risks in the Gubbio residential cohort study

J Hypertens. 2018 Sep;36(9):1825-1832. doi: 10.1097/HJH.0000000000001807.


Objective: The aim was to investigate whether office white-coat effect tail (OWCET), the waning of blood pressure (BP) after its waxing during office visit, predicted long-term major fatal and nonfatal events in the Gubbio residential cohort.

Methods: There were 3572 persons (44% men, 54 ± 11 years old) included. OWCET was defined as a decrease of 10 mmHg or more in SBP between the third and first measurement out of a series obtained a few min apart in which the second and third were considered actual baseline SBP at enrollment. Cardiovascular (CVD), including strokes and coronary heart disease (CHD) hard criteria incidences and deaths along with all-cause deaths were considered.

Results: Over 185 months median follow-up, individuals with OWCET had significantly higher risk factors except for smoking, which was less frequent. OWCET was associated with an increased risk of both CVD [HR 1.25 (95% CI 1.02-1.52)] and CHD [HR 1.35 (95% CI 1.01-1.80)] events independently of traditional risk factors (age, sex, total cholesterol, HDL, cigarettes and BMI) including SBP. When effective antihypertensive treatment was considered, there was a significant higher CVD risk in individuals with OWCET (P < 0.037). In uncontrolled or untreated individuals, those with OWCET also had a higher risk (P < 0.073).

Conclusion: In primary care, OWCET should be searched for as it can improve stratification of long-term CVD-CHD risks.

MeSH terms

  • Adult
  • Aged
  • Blood Pressure Determination
  • Blood Pressure*
  • Cardiovascular Diseases / epidemiology
  • Cause of Death
  • Cohort Studies
  • Female
  • Humans
  • Incidence
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Office Visits
  • Risk Factors
  • Stroke
  • White Coat Hypertension*