Blood pressure determinants of target organ damage among adults with white coat hypertension with a focus on nocturnal hypertension and blood pressure dipping

Abstract White coat hypertension (WCH) is still a grey zone regarding its management by clinicians, while its link to target organ damage (TOD) is still understudied. The aim of this study was to explore the impact of non-dipping status and nocturnal hypertension on TOD in untreated WCH subjects. A cross-sectional study of 547 individuals with WCH was conducted at a single institution. Patients underwent a thorough clinical examination, including medical history, office BP measurements, echocardiography, carotid artery ultrasonography, serum creatinine level measurements, and ambulatory blood pressure monitoring. Left ventricular hypertrophy (LVH), intima-media thickness of the common carotid artery (IMT-CCA) and estimated Glomerular Filtration Rate (eGFR) were used as TOD indices. The patients were divided into dippers and non-dippers, as well as nocturnal hypertensives and normotensives. Among WCH patients, 49.9% were non-dippers and 33.6% had nocturnal hypertension. Dippers had a significantly lower risk of left ventricular hypertrophy (OR: 0.68, 95%CI: 0.48 – 0.97) and higher mean expected eGFR values (b = 7.03, 95%CI: 3.12 – 10.94) than non-dippers. For IMT-CCA, office systolic and diastolic BP were the only significant predictors (b = 0.02, 95%CI: 0.00 – 0.03 and b = -0.03, 95%CI: -0.05 – -0.01). Office systolic BP was also significantly associated with eGFR (b = -1.68, 95%CI: -2.84 – -0.52). The results of this study indicate that non-dipping status is a significant risk factor for LVH and renal function in WCH subjects. Therefore, nighttime BP patterns, especially non-dipping, should be examined in patients with WCH.