Combination of Echocardiography and Pulse Wave Velocity Provides Clues for the Differentiation between White Coat Hypertension and Hypertension in Postmenopausal Women

OBJECTIVE: To determine whether or not noninvasive assessment of the cardiovascular system can discriminate white coat hypertension and hypertension in postmenopausal women. The major reason is the high prevalence of white coat hypertension in these subjects and the uncertain associations of white coat hypertension with cardiovascular risk. PATIENTS AND METHODS: Selected women were required to be naturally or surgically menopausal for at least 1 year but not more than 5 years past their menstrual period. White coat hypertension patients were defined as subjects who had office blood pressures >150/90 mm Hg but who had both systolic and diastolic ambulatory pressures <120/80 mm Hg. In total, 44 subjects with a mean age of 52 years were recruited from the outpatient clinic and examined. Office and home blood pressures were measured using the HEM 401C (Omron Life Science Co. Ltd., Tokyo, Japan), a semi-automatic device that operates on the cuff-oscillometric principle and generates a digital display of the systolic (SBP) and diastolic blood pressure as well as the pulse rate. The pulse wave velocity (PWV) was recorded, and the left ventricular (LV) diameter, septal wall thickness, and left posterior wall thickness were assessed by M-mode echocardiography after selecting the measurement section by B-mode echocardiography. RESULTS: Twenty patients were diagnosed as having white coat hypertension based on the criteria in the trial. Pulse wave patterns were different between subjects with white coat hypertension and those with hypertension. PWV of subjects with white coat hypertension was 1.32 ± 0.33 m/s and that of patients with hypertension was 1.46 ± 0.37 m/s (p < 0.01). In addition to these findings, there was a significant association between the values of home SBP and PWV and the LV mass index. However, this association was not seen for office SBP. When the data of the LV mass index and PWV were combined, white coat hypertension could be easily differentiated from hypertension. CONCLUSIONS: The combination of blood pressure self-monitoring, echocardiographic data, and PWV can be a powerful indicator for the treatment of hypertension in postmenopausal women.