White-coat hypertension during coronary computed tomography angiography is associated with higher coronary atherosclerotic burden

Cátia Costa, Pedro de Araújo Gonçalves, António Ferreira, Maria L Pitta, Hélder Dores, Nuno Cardim, Hugo Marques

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: White-coat hypertension (WCH) is a prevalent entity, which has been associated with an increased cardiovascular risk.

AIM: Assess whether WCH is associated with a higher coronary atherosclerotic burden, evaluated by coronary computed tomography angiography (CCTA) and coronary artery calcium (CAC) scoring.

METHODS: A total of 1362 patients who performed CCTA and simultaneous CAC for the assessment of coronary artery disease (CAD) were prospectively enrolled in a single-center registry and divided into three groups: (A) patients with normal blood pressure (BP) (n=386); (B) patients with WCH (n=174; without a history of hypertension or antihypertensive medication, but with systolic BP ≥140 and/or diastolic BP ≥90 mmHg before examination acquisition); and (C) patients with hypertension (n=802). The following coronary atherosclerotic markers were evaluated: CAC above the 50th percentile (CAC>p50), prevalence of CAD (any plaque), and obstructive CAD (plaque with>50% stenosis).

RESULTS: Patients with WCH had a higher coronary atherosclerotic burden compared with patients with normal BP for all markers (30.5 vs. 19.4%, P=0.004 for CAC>p50; 50.6 vs. 36.8%, P=0.002 for CAD, any plaque; and 13.8 vs. 8.3%, P=0.045 for obstructive CAD). On multivariate analysis, WCH was an independent predictor of a CAC>p50 [odds ratio (OR) 1.563, 95% confidence interval 1.018-2.400, P=0.041], but not of the presence of CAD (any plaque) (OR 1.335, P=0.169) or obstructive CAD (OR 1.376, P=0.301).

CONCLUSION: In this registry of patients, WCH was an independent predictor of a CAC above the p50. It was also associated with higher other markers of coronary atherosclerotic burden, such as the presence of CAD on CCTA, compared with patients with normal BP.

Original languageEnglish
Pages (from-to)57-62
Number of pages6
JournalCoronary Artery Disease
Volume28
Issue number1
DOIs
Publication statusPublished - Jan 2017

Keywords

  • Aged
  • Blood Pressure
  • Chi-Square Distribution
  • Computed Tomography Angiography
  • Coronary Angiography
  • Coronary Artery Disease
  • Coronary Stenosis
  • Coronary Vessels
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Plaque, Atherosclerotic
  • Portugal
  • Predictive Value of Tests
  • Prospective Studies
  • Registries
  • Risk Factors
  • Severity of Illness Index
  • White Coat Hypertension
  • Journal Article

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