Effects of white-coat, masked and sustained hypertension on coronary artery stenosis and cardiac arrhythmia

This study aimed to investigate whether hypertension phenotypes such as white-coat hypertension (WCHT), diagnosed with the addition of nighttime blood pressure (BP) criteria, are related to coronary artery stenosis (CAS) and cardiac arrhythmia. In this cross-sectional observational study, 844 participants who did not use antihypertensive, lipid-lowering, and antiplatelet drugs were selected. The subjects were divided into normotensive (NT), WCHT, masked hypertension (MHT), and sustained hypertension (SHT) groups based on the results of clinic BP measurement and ambulatory BP monitoring. Coronary angiography and ambulatory electrocardiography were performed to determine the participants' CAS and cardiac arrhythmia status. Coronary angiography revealed 556 patients with CAS and 288 participants with normal coronary arteries. The chi-squared test showed that the incidence of CAS was higher in the MHT and SHT groups than in the NT group, while no significant change was found in the WCHT group (P = 0.003, P < 0.001, P = 0.119). The logarithm of the Gensini score was used to compare the degree of CAS between the groups. Multiple linear regression analysis showed that the degree of CAS was higher in the WCHT, MHT, and SHT groups than in the NT group (P < 0.05). The incidences of frequent atrial premature beats, atrial tachycardia, and ventricular cardiac arrhythmia were significantly higher in the WCHT and SHT groups than in the NT group, while only ventricular cardiac arrhythmia changes were observed in the MHT group. This study found that hypertension phenotypes such as WCHT were closely associated with CAS and cardiac arrhythmia.