Original article The white coat effect is not associated with additional increase of target organ damage in true resistant hypertension Vale ´ ria Nasser Figueiredo a , Luiz Cla ´ udio Martins a , Leandro Boer-Martins a,b , Ana Paula Cabral de Faria a , Carolina de Haro Moraes a , Rodrigo Cardoso Santos a , Armando R. Nogueira c , Heitor Moreno Jr. a, * a Cardiovascular Pharmacology Laboratory, Faculty of Medical Sciences, University of Campinas (Unicamp), Campinas, SP, Brazil b Cardiovascular & Metabolism Unit, Pharma Sector, Novartis Biocieˆncias S.A., Sa˜o Paulo, Brazil c Hypertension Program, University Hospital Clementino Fraga Filho, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil Med Clin (Barc). 2013;140(1):1–5 A R T I C L E I N F O Article history: Received 25 January 2012 Accepted 19 April 2012 Available online 17 September 2012 Keywords: Resistant hypertension White coat effect Left ventricular hypertrophy Renal dysfunction A B S T R A C T Background and objective: White coat effect (WCE) (i.e., the difference between office blood pressure [OBP] and awake ambulatory blood pressure monitoring [ABPM]) may be present in hypertensive individuals. The relationship between occurrence of WCE and target organ damage (TOD) has not yet been assessed in true resistant hypertension (RHTN). Patients and methods: RHTN patients were divided into two groups: RHTN with WCE (WCE, n = 66) and RHTN without WCE (non-WCE, n = 61). All patients were submitted to OBP measurement, ABPM, echocardiography and renal function evaluation in three visits. Results: No differences were observed between the WCE and non-WCE groups regarding age, body mass index or gender. OBP were 169.8 Æ 15.8/95.1 Æ 14.0 (WCE) and 161.9 Æ 9.0/90.1 Æ 10.4 mmHg (non-WCE), ABPM = 143.0 Æ 12.8/86.1 Æ 9.9 (WCE) and 146.1 Æ 13.6/85.1 Æ 14.9 mmHg (non-WCE). No statistical differences were observed between WCE and non-WCE subgroups with respect to left ventricular mass index (LVMI) (WCE = 131 Æ 4.7; non-WCE = 125 Æ 2.9 g/m 2 ), creatinine clearance (WCE = 78 Æ 4.7; non- WCE = 80 Æ 3.6 ml/min/m 2 ) and microalbuminuria (MA) (WCE = 44 Æ 8.4; non-WCE = 49 Æ 6.8 mg/g Cr). Conclusions: This finding may suggest that WCE is not associated with additional increase of TOD in true RHTN subjects. ß 2012 Elsevier Espan ˜a, S.L. All rights reserved. El efecto de bata blanca sobre la presio ´n arterial en pacientes con hipertensio ´n resistente verdadera no se asocia con incremento adicional de lesiones en o ´ rganos diana Palabras clave: Hipertensio ´n arterial resistente Efecto de bata blanca Hipertrofia ventricular izquierda Enfermedad renal R E S U M E N Fundamento y objetivo: El efecto de bata blanca (EBB), es considerado cuando la diferencia entre la PAS/ PAD medida en consulta me ´ dica y aquella obtenida por monitorizacio ´n ambulatoria de la presio ´n arterial (MAPA) y puede estar presente durante la consulta me ´ dica en pacientes con hipertensio ´n arterial resistente (HTA-R). La relacio ´n entre la presencia del efecto bata blanca y dan ˜os en o ´ rganos diana au ´n no ha sido evaluada en individuos con HTA-R verdadera. Pacientes y me ´todo: En este estudio, sesenta y seis pacientes con HTA-R verdadera presentaron EBB y otros 61 no lo hicieron. A todos los sujetos se les practico ´ una monitorizacio ´n ambulatoria de la presio ´n arterial durante 24 horas (MAPA). La afectacio ´n de o ´ rganos diana se determino ´ mediante la realizacio ´n de ecocardiograma y evaluacio ´n de la funcio ´n renal. Resultados: Los valores de PAS y PAD en consulta me ´ dica fueron: 169,8 Æ 15,8/95,1 Æ 14,0 (pacientes con EBB) y 161,9 Æ 9,0/90,1 Æ 10,4 mmHg (pacientes sin EBB), respectivamente y mediante MAPA los valores promedios de PAS y PAD de 24 horas fueron: 143,0 Æ 12,8/86,1 Æ 9,9 (pacientes con EBB) y 146,1 Æ 13,6/ 85,1 Æ 14,9 mmHg (pacientes sin EBB), respectivamente. No se observaron diferencias significativas entre los pacientes con o sin EBB con respecto al ı ´ndice de masa ventricular izquierda (con EBB = 131 Æ 4,7; sin * Corresponding author. E-mail address: hmoreno@uol.com.br (H. Moreno Jr.). ww w.els evier.es /med ic in ac lin ic a 0025-7753/$ – see front matter ß 2012 Elsevier Espan ˜a, S.L. All rights reserved. http://dx.doi.org/10.1016/j.medcli.2012.04.031