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Main Factors Related with the White Coat Effect Level in Patients with Arterial Hypertension and Bronchial Asthma

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Aim. To study the main relationships of the white coat effect (WCE) levels in patients with arterial hypertension (AH) with bronchial asthma (BA) who treated with AH and BA drugs in routine clinical practice.

Material and Methods. We analyzed the prospective cohort study data of AH patients, some of them had BA without exacerbation. We have formed two groups of patients:1 - control group, patients with AH without BA, the second - with AH + BA. The study consisted of three visits (first visit, 6 months and 12 months visits) and data collection period (30.1±7.6 months of follow-up). The following procedures were performed at the first and 12 month visits: clinical blood pressure (BP) measurements (sitting and standing), 24-hour monitoring ambulatory (ABPM), spirometry, clinical and biochemical blood tests, BA control questionnaires (ACQ) and quality of life (QL) questionnaire (GWBQ), at the second visit clinical BP measurement was performed and, if necessary, the drug dose was corrected.

Results. The study included 125 patients, 28 men, 97 women. The first group of AH patients without BA included 85 people, the second (AH + BA) - 40. In AH patients without BA with ischemic heart disease, arterial revascularization, regular alcohol intake and smoking we identified the association with the lower WCE levels. In AH+BA patients with diabetes mellitus, gastrointestinal diseases, higher education was identified WCE decrease. In AH patients without asthma we found inverse relationships WCE levels with respiratory function parameters, the nighttime BP decrease, heart rate and the difference between standing and sitting BP levels, and correlations with the EchoCG variables (the left ventricular hypertrophy (LVH) indices), with age, AH duration and body mass index (BMI). In patients with AH + BA we found inverse correlations between WCE levels and some EchoCG variables, the difference between standing and sitting BP levels, and correlations with body weight, BMI.

Conclusion. Thereby, in AH patients without BA with ischemic heart disease, revascularization, regular alcohol intake, smoking we identified the association with the lower WCE levels. This patients WCE indices had inverse correlations with height, respiratory function parameters, the BP nighttime decrease, the difference between standing and sitting BP levels and direct relationships with EchoCG variables of LVH, age, AH duration and BMI. In AH + BA patients with diabetes, gastrointestinal diseases, higher education we found relationships with lesser WCE manifestation. WCE levels in this group had inverse correlations with some EchoCG indicators, the standing and sitting BP difference and direct relations with weight and BMI.

About the Authors

G. F. Andreeva
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Galiya F. Andreeva - eLibrary SPIN 5401-4631


M. I. Smirnova
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Marina I. Smirnova


V. M. Gorbunov
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Vladimir M. Gorbunov - eLibrary SPIN 5111-1303


A. S. Kurekhyan
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Kurekhyan Armine Saribekovna


Y. N. Koshelyaevskaya
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation

Yana N. Koshelyaevskaya



1. Balanova YA, Shalnova SA, Imaeva AE, et al. Prevalence, Awareness, Treatment and Control of Hypertension in Russian Federation (Data of Observational ESSERF-2 Study). Rational Pharmacotherapy in Cardiology. 2019;15(4):450-66 (In Russ.) DOI:10.20996/1819-6446-2019-15-4-450-466.

2. Boitsov SA, Balanova YA, Shal'nova SA, et al. Arterial hypertension among individuals of 25-64 years old: prevalence, awareness, treatment and control. By the data from ECCD. Cardiovascular Therapy and Prevention. 2014;4(14):4-14 (In Russ.) DOI:10.15829/1728-8800-2014-4-4-14.

3. Verberk WJ, Kroon AA, Thien T, et al. Prevalence of the white-coat effect at multiple visits before and during treatment. J Hypertens. 2006;24(12):2357-63. DOI:10.1097/01.hjh.0000251894.17132.54.

4. Hong D, Su H, Li J, et al. The effect of physician presence on blood pressure. Blood Press Monit. 2012;17(4):145-8. DOI:10.1097/mbp.0b013e328355fe14.

5. Andreadis EA, Angelopoulos ET, Agaliotis GD, et al. Why use automated office blood pressure measurements in clinical practice? High Blood Press Cardiovasc Prev. 2011;18(3):89-91. DOI:10.2165/11593510-000000000-00000.

6. Myers MG, Godwin M. Automated office blood pressure. Can J Cardiol. 2012;28(3):341-6. DOI:10.1016/j.cjca.2011.09.004.

7. Parati G, Ulian L, Sampieri L, et al. Attenuation of the "white-coat effect" by antihypertensive treatment and regression of target organ damage. Hypertension. 2000;35(2):614-20. DOI:10.1161/01.HYP.35.2.614.

8. Mancia G. White coat effect. Innocuous or adverse phenomenon? Eur Heart J. 2000;21:1647-8. DOI:10.1053/euhj.2000.2337.

9. Zakopoulos NA, Kotsis VT, Pitiriga VCh, et al. White-coat effect in normotension and hypertension. Blood Press Monit. 2002;7(5):271-6. DOI:10.1097/00126097-200210000-00004.

10. Chesnikova AI, Batyushin MM, Terentyev VP. Arterial hypertension and comorbidity: state of the art. Arterial Hypertension. 2016;22(5):432-40 (In Russ.) DOI:10.18705/1607-419X-2016-22-5-432-440.

11. Berdnikova LV, Dobrotina IS, Borovkov NN. The effect of arterial hypertension on the quality of life of patients with bronchial asthma. Arhiv Vnutrennej Mediciny. 2012;2(4):71-5 (In Russ.) DOI:10.20514/2226-6704-2016-6-1-28-33.

12. Siegrist J., Junge A. Conceptual and methodological problems in research on the quality of life in clinical medicine. Soc Sci Med. 1989;29(3):463-8. DOI:10.1016/0277-9536(89)90295-5.

13. Metelitsa VI, Douda SG, Ostrovskaya TP, et al. Long-term monotherapy with antihypertensives and quality of life in patients with mild to moderate arterial hypertension: a multicentre study. J Drug Dev Clin Pract. 1996;8(2):61-76.

14. Avdeev SN. The ACQ Questionnaire is a new tool for assessing control of asthma. Pulmonologiya. 2011;2:93-99 (In Russ.) [Авдеев С.Н. Опросник ACQ - новый инструмент оценки контроля над бронхиальной астмой. Пульмонология. 2011;2:93-9]. DOI:10.18093/0869-0189-2011-0-2-276-287.

15. Mule G, Nardi E, Cottone S, et al. Relationships between ambulatory white coat effect and left ventricular mass in arterial hypertension. Am J Hypertens. 2003;16(6):498-501. DOI:10.1016/s0895-7061(03)00843-4.

16. Verdecchia P, Schillaci G, Borgioni C. et al. Prognostic significance of the white-coat effect. Hypertension. 1997;29(6):1218-24. DOI:10.1161/01.hyp.29.6.1218.

17. Spannella F, Filipponi A, Giulietti F, et al. Prognostic role of masked and white-coat hypertension: 10Year mortality in treated elderly hypertensives. J Hum Hypertens. 2019;33(10):741-7. DOI:10.1038/s41371-018-0140-4.

18. Sheppard JP, Fletcher B, Gill P, et al. Predictors of the Home-Clinic Blood Pressure Difference: A Systematic Review and Meta-Analysis. Am J Hypertens. 2016;29(5):614-25. DOI:10.1093/ajh/hpv157.

19. Fujita H, Matsuoka S, Awazu M. White-Coat and Reverse White-Coat Effects Correlate with 24-h Pulse Pressure and Systolic Blood Pressure Variability in Children and Young Adults. Pediatr Cardiol. 2016;37(2):345-52. DOI:10.1007/s00246-015-1283-5.

20. Filipovsky J. White-coat hypertension and masked hypertension. Vnitr Lek. 2015;61(5):401-5. PMID:26075847.

21. Kang YY, Li Y, Huang QF. Accuracy of home versus ambulatory blood pressure monitoring in the diagnosis of white-coat and masked hypertension. J Hypertens. 2015;33(8):1580-7. DOI:10.1097/HJH.0000000000000596.

22. Tocci G, Presta V, Figliuzzi I, et al. Prevalence and clinical outcomes of white-coat and masked hypertension: Analysis of a large ambulatory blood pressure database. Clin Hypertens (Greenwich). 2018;20(2):297-305. DOI:10.1111/jch.13181

23. Gjon-Conde T, Graciani A, Lopez-Garda E, et al. Short-term variability and nocturnal decline in ambulatory blood pressure in normotension, white-coat hypertension, masked hypertension and sustained hypertension: a population-based study of older individuals in Spain. Hypertens Res. 2017;40(6):613-9. DOI:10.1038/hr.2017.9.

24. Matsuoka H. Masked hypertension. Nihon Rinsho. 2014;72(8):1415-8. PMID: 25167745.

25. Hanninen MR, Niiranen TJ, Puukka PJ, et al. Determinants of masked hypertension in the general population: the Finn-Home study. Am J Hypertens. 2011;29(10):1880-8. DOI:10.1097/HJH.0b013e32834a98ba.

26. Conen D, Aeschbacher S, Thijs L, et al. Age-specific differences between conventional and ambulatory daytime blood pressure values. Hypertension. 2014;64(5):1073-9. DOI:10.1161/HYPERTENSIONAHA.114.03957.

27. Barochiner J, Cuffaro PE, Aparicio LS. Predictors of masked hypertension among treated hypertensive patients: an interesting association with orthostatic hypertension. Am J Hypertens. 2013;26(7):872- 8. DOI:10.1093/ajh/hpt036.

28. Tabara Y, Igase M, Miki T, et al. Orthostatic hypertension as a predisposing factor for masked hypertension: the J-SHIPP study. Hypertens Res. 2016;39(9):664-9. DOI:10.1038/hr.2016.43

For citation:

Andreeva G.F., Smirnova M.I., Gorbunov V.M., Kurekhyan A.S., Koshelyaevskaya Ya.N. Main Factors Related with the White Coat Effect Level in Patients with Arterial Hypertension and Bronchial Asthma. Rational Pharmacotherapy in Cardiology. 2021;17(2):212-220. (In Russ.)

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