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White-Coat Hypertension as a Risk Factor for the Development of Home Hypertension
The Ohasama Study
Takashi Ugajin, MS;
Atsushi Hozawa, MD, PhD;
Takayoshi Ohkubo, MD, PhD;
Kei Asayama, MD;
Masahiro Kikuya, MD, PhD;
Taku Obara, MS;
Hirohito Metoki, MD;
Haruhisa Hoshi, MD, PhD;
Junichiro Hashimoto, MD, PhD;
Kazuhito Totsune, MD, PhD;
Hiroshi Satoh, MD, PhD;
Ichiro Tsuji, MD, PhD;
Yutaka Imai, MD, PhD
Arch Intern Med. 2005;165:1541-1546.
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  140/90 mm Hg) for 8 years and compared the risk of progression with home hypertension (home BP 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.
Author Affiliations: Departments of Clinical Pharmacology and Therapeutics (Messrs Ugajin and Obara and Drs Asayama, Metoki, Totsune, and Imai), Public Health (Drs Hozawa and Tsuji), Planning for Drug Development and Clinical Evaluation Health (Drs Ohkubo, Kikuya, and Hashimoto), and Environmental Health Sciences (Dr Satoh), Tohoku University Graduate School of Medicine and Pharmaceutical Sciences, Tohoku University 21st Century Center of Excellence (COE) Program "Comprehensive Research and Education Center for Planning for Drug Development and Clinical Evaluation," Sendai, Japan (Drs Ohkubo, Asayama, Metoki, Hashimoto, Totsune, Satoh, and Imai); and Ohasama Hospital, Iwate, Japan (Dr Hoshi).
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