Arterial distensibility in subjects with white-coat hypertension with and without diabetes or dyslipidaemia: comparison with normotensives and sustained hypertensives

Abstract

Objective To determine whether diabetes, smoking and dyslipidaemia were associated with greater than normal stiffness of aortic walls in subjects with white-coat hypertension. Methods Arterial distensibility was assessed by automatic measurement of carotid-femoral PWV in 35 healthy normotensives, 46 white-coat hypertensives (WCH, clinic blood pressures > 140/90 mmHg, daytime blood pressures < 130/85 mmHg) and 81 ambulatory hypertensives (clinic blood pressures > 140/90 mmHg, daytime blood pressures greater than or equal to 130 mmHg systolic or greater than or equal to 85 mmHg diastolic, or both) all matched for age, sex and body mass index, Nineteen normotensives (subgroup A), 28 WCH (subgroup A) and 37 ambulatory hypertensives (subgroup A) had only one or no other major cardiovascular risk factor whereas 16 normotensives (subgroup B), 18 WCH (subgroup B) and 44 ambulatory hypertensives (subgroup B) had also some combination of non-insulin-dependent diabetes, a smoking habit and dyslipidaemia. Results Both for the WCH and for ambulatory hypertensives diabetes and dyslipidaemia (subgroups B) were associated with higher (P < 0.04) PWV (11.6 +/- 0.3 and 12.8 +/- 0.3 m/s, respectively) than for subgroups A (9.3 +/- 0.5 and 10.9 +/- 0.6 m/s, respectively). In contrast, PWV for WCH in subgroup A (9.3 +/- 0.5 m/s) did not differ (P > 0.35) from those for the normotensive subgroups A (9.2 +/- 0.3 m/s) and B (9.6 +/- 0.4 m/s), PWV was not correlated to levels of glycaemia, glycosylated haemoglobin and cholesterolaemia. Conclusions These results suggest that, both for ambulatory hypertensives and for WCH, diabetes and dyslipidaemia are associated with an impairment of arterial distensibility that can entail a greater than normal cardiovascular risk, which might dictate a more than usually stringent treatment of concomitant risk factors and possibly of high blood pressure. In contrast, PWV in WCH of the subgroup A did not differ from those in normotensives, reinforcing the hypothesis that WCH is associated with a benign cardiovascular outcome in the absence of other cardiovascular risk factors. (C) 2000 Lippincott Williams & Wilkins.