Nocturnal blood pressure fall and metabolic syndrome score in patients with white coat hypertension

Background Accumulating data report that white coat hypertension (WCH) is associated with target organ damage. Metabolic syndrome (MS), and nondipping pattern is also associated with increased cardiovascular risk. The purpose of this study was to explore the nocturnal blood pressure fall in WCH patients according to their MS score. Methods The study comprised 2300 patients with WCH who attended our outpatient clinics. All underwent repeated office blood pressure measurements, 24-h ambulatory blood pressure monitoring, full clinical and laboratory evaluation. The diagnosis of MS was made according to the Adult Treatment Panel III criteria and patients were classified into five groups: group I (hypertension), group II (hypertension and any one component), group III (hypertension and any two components), group IV (hypertension and any three components), and group V (all five components). Dipping pattern was defined as 'dippers' with nocturnal systolic blood pressure (NSBP) fall greater than or equal to 10% but less than 20%, 'nondippers' with NSBP fall greater than or equal to 0% but less than 10%, 'extreme dippers' with NSBP fall greater than or equal to 20%, and 'reverse dippers' with NSBP increase. Results Patients were divided into two groups according to the presence (n=522) and absence (n=1778) of MS. The overall prevalence of MS in the study population was 22.7%. Comparing the non-MS group with the MS we observed significant differences for nondippers (24.5% vs. 38.9%, P<0.001), dippers (54.4% vs. 43.5%, P<0.001), extreme dippers (17.8% vs. 11.3%, P<0.001), and reverse dippers (3.3% vs. 6.3%, P=0.007). Conclusion Patients with WCH and increased number of MS components present with elevated nighttime SBP levels. This observation is of a great significance in the assessment of the cardiovascular risk in these patients.