Clinical Predictors of Significant White-Coat Effect in Non-Diabetic Hypertensive Patients

Background: The presence of a clinically important white-coat effect (WCE) may lead to incorrect hypertension management. The aim of our study was to investigate the possible causes of WCE in non-diabetic hypertensive patients. Methods: Consecutive non-diabetic hypertensive patients were evaluated. A comprehensive history-taking and physical check-up were conducted. All patients received a series of studies including office blood pressure (BP), 24-hour ambulatory BP recording, and blood sampling. WCE was defined as the difference between office systolic BP (SBP) and daytime SBP. Significant WCE was defined as [(office SBP - daytime SBP)/office SBP >= 10%]. Results: Totally 121 patients (mean age 45.70 +/- 10.61 years, 45 females) were enrolled into our study. Totally 33 patients (27.3%) had significant WCE in the study. Patients with significant WCE had more female gender (p < 0.001), lower body mass index (p = 0.012), higher office SBP (p < 0.001), lower office heart rate (HR, p = 0.005), lower triglyceride (p = 0.008), alanine aminotransferase (p = 0.021) and aspartate aminotransferase (p = 0.008), and higher high-density lipoprotein-cholesterol (p = 0.039). Multivariate analysis showed that female gender [odds ratio (OR) 3.290, 95% confident interval (CI) 1.018-10.631, p = 0.047], office SBP (OR 1.079, 95% CI 1.034-1.125, p < 0.001), and office HR (OR 0.930, 95% CI 0.885-0.978, p = 0.005) could predict the patients with significant WCE. Conclusion: Significant WCE could be predicted by female gender, higher office SBP, and lower office HR. Our current study may help us to identify patients with WCE and to improve the treatment of non-diabetic hypertensive patients.