Is white-coat hypertension a risk factor for carotid atherosclerosis? A review and meta-analysis

The association of white-coat hypertension (WCH) with target organ damage is still debated; in particular, the relationship of this blood pressure phenotype with subclinical vascular damage remains controversial. Thus, we carried out a systematic review and meta-analysis to provide updated information on carotid structural changes in WCH. Studies were identified using the following search terms: 'white coat hypertension', 'isolated clinic hypertension', 'carotid artery', 'carotid atherosclerosis', 'carotid intima-media thickness', 'carotid damage', 'carotid thickening'. Full articles published in the English language in the last two decades reporting studies on adults were considered. A total of 3478 untreated patients, 940 normotensive (48% men), 666 WCH (48% men), and 1872 hypertensive individuals (57% men) included in 10 studies, were analyzed. Common carotid intima-media thickness (IMT) showed a progressive increase from normotensive (718± 36 μm) to WCH (763± 47 μm, standardized mean difference 0.54 ±0.13, P