Should White-Coat Hypertension in Diabetes Be Treated? Pro

W hite coat hypertension, which should be more descriptively termed “isolated clinic hypertension” (1), consists of a condition in which clinic (or office) blood pressure is repeatedly 140 mmHg systolic or 90 mmHg diastolic, whereas 24-h mean blood pressure is below its generally accepted upper limit of normality, i.e., 125/80 mmHg (1,2). This article will first show evidence from the PAMELA (Pressioni Arteriose Monitorate E Loro Associazioni) population study that isolated clinic hypertension is associated with a prevalence of organ damage and a risk of cardiovascular morbidity and mortality, which, although less than those of patients with inand out-of-office hypertension, are distinctly greater than those displayed by truly normotensive subjects. It will then emphasize that in diabetic subjects, limited evidence is available on the prevalence of isolated clinic hypertension as well as on its association with diabetic-related microvascular and macrovascular disease. In this context, some specific difficulties exist, i.e., 1) the uncertainty about whether the cut-off clinic and ambulatory blood pressure values to use should (or should not) be different from those used in nondiabetic individuals, 2) the small number of subjects and events in the few studies that have addressed this issue, and 3) the confounding effect of factors such as the duration of diabetes, the extent and type of blood pressure–lowering treatments, and the more or less effective blood glucose control when subjects with and without isolated clinic hypertension are compared. It will be concluded, however, that recommendations on this matter should take into due account that, in diabetes, cardiovascular and renal protection are enhanced by aggressive reductions in clinic blood pressure ( 130/80 mmHg) and that lowering blood pressure is beneficial even when the initial clinic value is within the normal blood pressure range, i.e., 130–139 mmHg (2). This scores in favor of a systematic blood pressure– lowering intervention in this condition.