Are the cardiovascular outcomes of participants with white-coat hypertension poor compared to those of participants with normotension? A systemic review and meta-analysis.

The prognostic value of white-coat hypertension (WCH) remains controversial. We undertook a quantitative literature review to assess the risk of cardiovascular outcomes in untreated participants with WCH compared to that in participants with normotension. We searched databases (PubMed, Cochrane Library and the Ichu-Shi Web Japanese database) for peer-reviewed articles published until December 23, 2017 reporting studies evaluating the risk of cardiovascular outcomes in participants with WCH compared to that in participants with normotension. WCH was defined by having hypertension according to the conventional office blood pressure (BP) and being in the normotensive range (definitions of hypertension and normotension differed according to studies) for out-of-office BP measured at home or in an ambulatory setting. In total, 11 studies were included in the meta-analysis, which assessed the composite outcomes of morbidity and mortality on cardiovascular, stroke, and cardiac diseases, all-cause mortality, and deterioration to sustained hypertension in 8 (n = 11971), 2 (n = 6252), 2 (n = 6252), 5 (n = 10611), and 3 (n = 1722) studies, respectively. The risks for cardiovascular outcome and deterioration to sustained hypertension were significantly higher in WCH participants, with relative risks (95% confidence intervals) of 1.33 (1.10-1.62) and 2.85 (2.32-3.49), respectively, than in participants with normotension. In contrast, no significant differences were observed in the risk for stroke, cardiac outcomes or all-cause mortality. Our study suggests the importance of accurate and appropriate evaluation of WCH by utilizing out-of-office BP monitoring and the necessity for careful long-term follow-up of participants with WCH.

Arterial-cardiac destiffening following long-term antihypertensive treatment.

BACKGROUND: We examined whether in addition to producing a greater degree of improvement of the arterial stiffness, long-term angiotensin II receptor blocker (ARB) treatment might also have a more beneficial effect on the cardiac diastolic dysfunction than long-term calcium-channel blocker (CCB) treatment; we also evaluated the association between the improvements of the two variables brought about by ARB treatment in subjects with stage I or II hypertension. METHODS: One hundred and thirteen patients were randomly allocated to treatment with an ARB (candesartan) or a CCB (amlodipine). Echocardiography and measurement of the brachial-ankle pulse wave velocity (PWV) were conducted in both groups at the start of the treatment and at the end of 2-3-years' treatment. RESULTS: After adjustments for covariates, the extent of reduction of the brachial-ankle PWV (-200 ± 18 cm/s vs. -141 ± 18 cm/s, P = 0.03) and that of the increase of the E/A ratio (0.08 ± 0.03 vs. 0.01 ± 0.03, P = 0.04) were significantly greater in the candesartan group than in the amlodipine group. A significant relationship was identified between the delta changes of the brachial-ankle PWV and delta changes of the E/A ratio observed following long-term candesartan treatment. CONCLUSION: Long-term candesartan treatment may have a more beneficial effect on the stiffness of the large- to- middle-sized arteries than long-term amlodipine treatment, and this treatment may also concomitantly improve the cardiac diastolic dysfunction; a significant association appeared to exist between the improvements of the two variables observed following long-term candesartan treatment.

Effects of CPAP therapy on the sympathovagal balance and arterial stiffness in obstructive sleep apnea.

OBJECTIVE: Increased arterial stiffness and sympathovagal imbalance are noted in patients with obstructive sleep apnea (OSA). It has been thought that continuous positive airway pressure (CPAP) therapy can have beneficial effects on the vascular function in such cases. However, it is not yet clear whether the improvement of sympathovagal balance by CPAP might be related to reduction of the arterial stiffness, independent of changes in the blood pressure. METHODS: In 50 consecutive eligible patients with OSA (apnea-hypopnea index>/=20/hour) receiving CPAP therapy, the brachial-ankle pulse wave velocity (baPWV), heart rate variability (LF, HF and LF/HF ratio), baroreceptor sensitivity (BRS), plasma levels of C-reactive protein (CRP), and endothelial function as assessed by changes in the forearm blood flow before and after reactive hyperemia (END) were measured before and after 3-months' CPAP therapy. RESULTS: Significant decrease of the LF/HF ratio, plasma levels of CRP, baPWV and heart rate were observed after 3 months' CPAP therapy. The change in the baPWV following 3-months' CPAP therapy was significantly correlated with the change in the LF/HF ratio and mean blood pressure (MBP), but not with that of the BRS, CRP or END after the therapy. Multivariate linear regression analysis demonstrated a significant correlation between the change in the LF/HF ratio and that in the baPWV (beta=0.305, p=0.041), independent of the changes in the MBP, plasma CRP levels and heart rate. CONCLUSIONS: Improvement of the sympathovagal balance by CPAP therapy may be significantly related to decreased stiffness of the central to middle-sized arteries, independent of the changes in the blood pressure and vascular endothelial status.