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ASH: White Coat Hypertension Not Uniform For Both Diastolic and Systolic Blood Pressure By Maggie Schwarz NEW YORK, NY -- May 18, 2003 -- White coat hypertension may have a separate effect on diastolic and systolic high blood pressure, and even on heart rate, according to results of a multicenter genetic study presented here on May 16th here at the 18th Annual Scientific Meeting of the American Society of Hypertension. Michal Hoffmann, MD, of the Medical University of Gdansk, Gdansk, Poland, explained the clinical implication of the findings on the specifics of white coat hypertension. The study, led by Mikolaj Winnicki, MD, also of the Medical University of Gdansk, evaluated 255 patients with untreated mild-to-moderate borderline hypertension. They studied 3 polymorphisms associated with hypertension to determine their relationship to white coat hypertension, including angiotensinogen (AGT), angiotensin-converting enzyme (ACE) and the beta 3 subunit of G protein (GNB3). white coat hypertension was defined as the difference between office and daytime ambulatory blood pressure and heart rate. In a univariate analysis, none of the 3 polymorphisms wereassociated with systolic white coat hypertension or a white coat effect on heart rate. Diastolic white coat hypertension was seen in subjects with the ACE (P=.043), AGT (P<.0001) and GNB3 (P=.08) polymorphisms. Multivariate analysis found that ACE (P<.05), GNB3 (P<.05) and AGT (P<.0001) were independently associated with a higher diastolic white coat effect. Negative family history of hypertension (P<.03) and alcohol consumption (P=.025) were also associated with a higher diastolic white coat effect. The researchers concluded that the differential association of the 3polymorphisms to diastolic white coat hypertension supports the individual evaluation of a white coat effect on systolic blood pressure, diastolic blood pressure, and heart rate. "One should not assume a collective, generic, or uniform white-coat effect, " Dr. Hoffmann said. He added that there definitely is a genetic link for diastolic white coat hypertension, but that a genetic association for systolic white coat hypertension and heart rate is unproven. "We would need 1000 subjects to [find] that, and we had only 255," he noted. Dr. Hoffmann also said that there are so many genes potentially involved in BP regulation that it is very difficult to assess which ones affect BP values. "Hundreds of candidate genes might be associated with hypertension," he added. [Study title: Is White Coat Effect A Uniform Phenomenon? Abstract P-122] E-mail this page to a friend or colleague! To print, use this version