Post-stroke white coat hypertension/effect is associated with greater arterial stiffness

Objective White coat hypertension/effect (WCH/E) describes an elevated clinic blood pressure (BP) with normal daytime ambulatory BP (ABPM) values. It is not clear whether WCH/E is associated with adverse vascular risk. This study aimed to determine the relationship between WCH/E and arterial stiffness in a cohort of patients who had a transient ischaemic attack (TIA) or lacunar stroke (LS). Design and method The Arterial Stiffness In Lacunar Stroke and TIA (ASIST) study recruited 96 patients, age >40-years-old, with a confirmed diagnosis of TIA or LS in the preceding 14 days. Patients were grouped by BP. Thirty-four patients were excluded (n=6 declined ABPM, n=3 masked hypertension and n=25 sustained hypertension). Thirty-two patients with normal BP (clinic BP <140/90mmHg and day-time ABPM <135/85mmHg), and 30 patients with WCH/E (clinic BP >/= 140/90mmHg and day-time ABPM <135/85mmHg) were recruited. Arterial stiffness was measured using carotid-femoral pulse wave velocity (PWV), (Complior®, ALAM Medical) and carotid-ankle vascular index (CAVI), (VaSera VS-1500N®, Fukuda Denshi). Results Compared to patients with normal BP, patients with WCH/E were older, had a higher body mass index (BMI) and higher arterial stiffness measured by CAVI (10.3±1.3 vs 9.4±1.7, p=0.027), and PWV (11.9±3.0 vs 9.6±2.3 ms-¹, p=0.002). The WCH/E cohort had more lacunar strokes (p=0.039). Conclusions In this population of post-stroke patients, those with WCH/E had greater arterial stiffness and a higher prevalence of lacunar stroke. These results suggest that WCH/E is associated with adverse cardiovascular risk.