• Jordana B Cohen, Michael J Lotito, Usha K Trivedi, Matthew G Denker, Debbie L Cohen, and Raymond R Townsend.
• University of Pennsylvania, Philadelphia, Pennsylvania (J.B.C., M.G.D., D.L.C., R.R.T.).
• Ann. Intern. Med. 2019 Jun 18; 170 (12): 853-862.

BackgroundThe long-term cardiovascular risk of isolated elevated office blood pressure (BP) is unclear.PurposeTo summarize the risk for cardiovascular events and all-cause mortality associated with untreated white coat hypertension (WCH) and treated white coat effect (WCE).Data SourcesPubMed and EMBASE, without language restriction, from inception to December 2018.Study SelectionObservational studies with at least 3 years of follow-up evaluating the cardiovascular risk of WCH or WCE compared with normotension.Data Extraction2 investigators independently extracted study data and assessed study quality.Data Synthesis27 studies were included, comprising 25 786 participants with untreated WCH or treated WCE and 38 487 with normal BP followed for a mean of 3 to 19 years. Compared with normotension, untreated WCH was associated with an increased risk for cardiovascular events (hazard ratio [HR], 1.36 [95% CI, 1.03 to 2.00]), all-cause mortality (HR, 1.33 [CI, 1.07 to 1.67]), and cardiovascular mortality (HR, 2.09 [CI, 1.23 to 4.48]); the risk for WCH was attenuated in studies that included stroke in the definition of cardiovascular events (HR, 1.26 [CI, 1.00 to 1.54]). No significant association was found between treated WCE and cardiovascular events (HR, 1.12 [CI, 0.91 to 1.39]), all-cause mortality (HR, 1.11 [CI, 0.89 to 1.46]), or cardiovascular mortality (HR, 1.04 [CI, 0.65 to 1.66]). The findings persisted across several sensitivity analyses.LimitationPaucity of studies evaluating isolated cardiac outcomes or reporting participant race/ethnicity.ConclusionUntreated WCH, but not treated WCE, is associated with an increased risk for cardiovascular events and all-cause mortality. Out-of-office BP monitoring is critical in the diagnosis and management of hypertension.Primary Funding SourceNational Institutes of Health.

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