Topography and severity of coronary artery disease in white-coat hypertension.

Abstract

BACKGROUND: White-coat hypertension (WCH) has been evaluated as a risk factor for cardiovascular disease. In this study, the role of WCH is evaluated in a cohort of patients with suspected coronary artery disease with both coronary angiography and non-invasive techniques. METHODS: One hundred patients with suspected coronary artery disease underwent coronary angiography, 24-h ambulatory blood pressure monitoring (ABPM), and ultrasound imaging of the myocardium and carotids. The lesions in percentage of stenosis in the left coronary artery stem (LM), left anterior descending ramus (LAD), left circumflex artery (LCX), diagonal artery (D1), and right coronary artery (RCA), along with the Gensini score (GS), were recorded. After a series of manual blood pressure measurements, the patients were divided into two groups (patients with and patients without WCH). RESULTS: GS was higher in the WCH group (P=0.042), a difference that could be attributed to lesions in the LAD (P=0.007). GS correlated significantly with left ventricular end-diastolic diameter (LVEDD - P=0.041), left ventricular end-systolic diameter (LVESD - P=0.005), end-diastolic volume (EDV - P=0.042), end-systolic volume (ESV - P=0.004), LvMass/BSA (P=0.012), right internal carotid artery intima-media thickness (RICA - P=0.018), left internal carotid artery intima-media thickness (LICA - P=0.021), and their mean (MICA - P=0.005) in the WCH group but not in normotensives. CONCLUSIONS: Coronary disease may be more severe among patients with WCH than among those without. In this group, data from myocardial and carotid ultrasound may help to estimate coronary artery disease.