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We have read the article by Muldoon et al¹ on the association between white-coat hypertension and carotid artery disease in community samples. The authors carefully matched subjects with normotension, white-coat hypertension, and sustained hypertension for both clinic blood pressure (BP) and ambulatory BP, and found that carotid artery atherosclerosis (defined by an increase in the intimal-medial thickness and plaque index) was more advanced in the patients with white-coat hypertension than in controls with normotension, and was comparable with what was found in the patients with sustained hypertension. Given this evidence, the authors concluded that the isolated elevation of BP in the office, which is the hallmark of white-coat hypertension, should not be considered benign. However, we believe that their findings can be interpreted differently.

The first issue concerns their definitions. Their criteria for white-coat hypertension were rather loose (a clinic BP 140/90 mm Hg and ambulatory BP <140/90 mm Hg). . . . [Full Text of this Article]

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