Arterial aging may link cardiovascular risk to white coat hypertension (WCH). The aims of the present study were to investigate the role of arterial aging in the white coat effect, defined as the difference between office and 24-hour ambulatory systolic blood pressures, and to compare WCH with pre-hypertension (PH) with respect to target organ damage and long-term cardiovascular mortality. A total of 1257 never-been-treated volunteer subjects from a community-based survey were studied. WCH and PH were defined by office and 24-hour ambulatory blood pressures. Left ventricular mass index, carotid intima-media thickness (IMT), estimated glomerular filtration rate (eGFR), carotid-femoral pulse wave velocity (cf-PWV), carotid augmentation index (AIx), amplitude of the reflection pressure wave (Pb), and 15-year cardiovascular mortality were determined. Subjects with WCH were significantly older and had greater body mass index, blood pressure values, IMT, cf-PWV, AIx, and Pb, and a lower eGFR than PH. Pb was the most important independent correlate of the white coat effect in multi-variate analysis (model r2 = 0.451; partial r2/model r2 = 90.5%). WCH had significantly greater cardiovascular mortality than PH (hazard ratio and 95% confidence interval, 2.94, 1.09–7.91), after accounting for age, gender, body mass index, smoking, fasting plasma glucose, and total cholesterol/high density lipoprotein cholesterol ratio. Further adjustment of the model for Pb eliminated the statistical significance of the WCH effect. In conclusion, the white coat effect is mainly due to arterial aging. WCH carries higher risk for cardiovascular mortality than PH, probably via enhanced wave reflections that accompany arterial aging.
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