| Summary: | Objective: White coat hypertension/effect (WCH/E) describes an elevated clinic blood pressure (BP) with normal daytime ambulatory BP (ABPM) values. It is not clear whether WCH/E is associated with adverse vascular risk. This study aimed to determine the relationship between WCH/E and arterial stiffness in a cohort of patients who had a transient ischaemic attack (TIA) or lacunar stroke (LS).
Design and Method: The Arterial Stiffness In Lacunar Stroke and TIA (ASIST) study recruited 96 patients, aged over 40 years old, with a confirmed diagnosis of TIA or LS in the preceding 14 days. Patients were grouped by BP. Thirty-four patients were excluded (n = 6 declined ABPM, n = 3 masked hypertension and n = 25 sustained hypertension). Thirty-two patients with normal BP (clinic BP < 140/90 mmHg and day-time ABPM < 135/85 mmHg), and 30 patients with WCH/E (clinic BP > 140/90 mmHg and day-time ABPM < 135/85 mmHg) were recruited. Arterial stiffness was measured using carotid-femoral pulse wave velocity (PWV), (Complior®, ALAM Medical) and carotid-ankle vascular index (CAVI), (VaSera VS-1500 N®, Fukuda Denshi).
Results: Compared to patients with normal BP, patients with WCH/E were older, had a higher body mass index (BMI) and higher arterial stiffness measured by CAVI (10.3 ± 1.3 vs 9.4 ± 1.7, p = 0.027), and PWV (11.9 ± 3.0 vs 9.6 ± 2.3 ms−1, p = 0.002). The WCH/E cohort had more lacunar strokes (p = 0.039).
Conclusion: In this population of post-stroke patients, those with WCH/E had greater arterial stiffness and a higher prevalence of lacunar stroke. These results suggest that WCH/E is associated with adverse cardiovascular risk.
Normotension (N = 32)
WCH/E (N = 30)
Statistical significance
Male, n (%)
21(66)
22(73)
0.511
Age (years)
69.9 ± 11.5
75.7 ± 9.3
0.033
BMI (kg/m2)
25 ± 4
28 ± 4
0.014
Anti-hypertensive use, n (%)
19(59)
23(77)
0.146
Clinic systolic BP (mmHg)
125 ± 9
155 ± 13
<0.001
Clinic diastolic BP (mmHg)
75 ± 7
81 ± 8
0.003
Daytime systolic ABPM (mmHg)
114 ± 10
121 ± 10
0.007
Daytime diastolic ABPM (mmHg)
73 ± 7
72 ± 7
0.586
CAVI
9.4 ± 1.7
10.3 ± 1.3
0.027
PWV (ms−1)
9.6 ± 2.3
11.9 ± 3.0
0.002
Stroke type
TIA, n (%)
25(78)
16(53)
0.039
Lacunar, n (%)
7(22)
14(47)
Data expressed as mean ± standard deviation or number (percentage). Significance determined by t-test. Chi-squared used for anti-hypertensive use, gender and stroke type.
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