White-coat hypertension during coronary computed tomography angiography is associated with higher coronary atherosclerotic burden.

Introduction: White-coat hypertension (WCH) is a prevalent entity, which has been associated with an increased cardiovascular risk. Aim: Assess whether WCH is associated with a higher coronary atherosclerotic burden, evaluated by coronary computed tomography angiography (CCTA) and coronary artery calcium (CAC) scoring. Methods: A total of 1362 patients who performed CCTA and simultaneous CAC for the assessment of coronary artery disease (CAD) were prospectively enrolled in a single-center registry and divided into three groups: (A) patients with normal blood pressure (BP) (n=386); (B) patients with WCH (n=174; without a history of hypertension or antihypertensive medication, but with systolic BP ≥140 and/or diastolic BP ≥90 mmHg before examination acquisition); and (C) patients with hypertension (n=802). The following coronary atherosclerotic markers were evaluated: CAC above the 50th percentile (CAC>p50), prevalence of CAD (any plaque), and obstructive CAD (plaque with>50% stenosis). Results Patients with WCH had a higher coronary atherosclerotic burden compared with patients with normal BP for all markers (30.5 vs. 19.4%, P=0.004 for CAC>p50; 50.6 vs. 36.8%, P=0.002 for CAD, any plaque; and 13.8 vs. 8.3%, P=0.045 for obstructive CAD). On multivariate analysis, WCH was an independent predictor of a CAC>p50 [odds ratio (OR) 1.563, 95% confidence interval 1.018-2.400, P=0.041], but not of the presence of CAD (any plaque) (OR 1.335, P=0.169) or obstructive CAD (OR 1.376, P=0.301). Conclusion: In this registry of patients, WCH was an independent predictor of a CAC above the p50. It was also associated with higher other markers of coronary atherosclerotic burden, such as the presence of CAD on CCTA, compared with patients with normal BP.