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Association Between White-Coat Effect and Blunted Dipping of Nocturnal Blood Pressure

Bochud, Murielle ; Bovet, Pascal ; Vollenweider, Peter ; Maillard, Marc ; Paccaud, Fred ; Wandeler, Gilles ; Gabriel, Anne ; Burnier, Michel

In: American Journal of Hypertension, 2009, vol. 22, no. 10, p. 1054-1061

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    Title
    • Association Between White-Coat Effect and Blunted Dipping of Nocturnal Blood Pressure
    Author
    • Bochud, Murielle. Institut Universitaire de Médecine Sociale et Préventive, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
    • Bovet, Pascal. Institut Universitaire de Médecine Sociale et Préventive, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
    • Vollenweider, Peter. Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
    • Maillard, Marc. Department of Medicine, Division de Néphrologie et Consultation d'Hypertension, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
    • Paccaud, Fred. Institut Universitaire de Médecine Sociale et Préventive, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
    • Wandeler, Gilles. Institut Universitaire de Médecine Sociale et Préventive, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
    • Gabriel, Anne. Ministry of Health and Social Development, Victoria, Republic of Seychelles
    • Burnier, Michel. Department of Medicine, Division de Néphrologie et Consultation d'Hypertension, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
    Document Type
    • Postprint
    Language
    • English
    Published in
    • American Journal of Hypertension, 2009, vol. 22, no. 10, p. 1054-1061. Oxford University Press
    Other Version
    Classification
    • Health
    OAI-PMH Identifier
    • oai:doc.rero.ch:292420
    Summary
    Background In this study, we assessed whether the white-coat effect (difference between office and daytime blood pressure (BP)) is associated with nondipping (absence of BP decrease at night). Methods Data were available in 371 individuals of African descent from 74 families selected from a population-based hypertension register in the Seychelles Islands and in 295 Caucasian individuals randomly selected from a population-based study in Switzerland. We used standard multiple linear regression in the Swiss data and generalized estimating equations to account for familial correlations in the Seychelles data. Results The prevalence of systolic and diastolic nondipping (<10% nocturnal BP decrease) and white-coat hypertension (WCH) was respectively 51, 46, and 4% in blacks and 33, 37, and 7% in whites. When white coat effect and nocturnal dipping were taken as continuous variables (mm Hg), systolic (SBP) and diastolic BP (DBP) dipping were associated inversely and independently with white-coat effect (P < 0.05) in both populations. Analogously, the difference between office and daytime heart rate was inversely associated with the difference between daytime and night-time heart rate in the two populations. These results did not change after adjustment for potential confounders. Conclusions The white-coat effect is associated with BP nondipping. The similar associations between office-daytime values and daytime-night-time values for both BP and heart rate suggest that the sympathetic nervous system might play a role. Our findings also further stress the interest, for clinicians, of assessing the presence of a white-coat effect as a means to further identify patients at increased cardiovascular risk and guide treatment accordingly