Reproducibility of blood pressure variability, white-coat effect and dipping pattern in untreated, uncomplicated and newly diagnosed essential hypertension

Objective: To investigate the reproducibility of blood pressure (BP) variability, white-coat effect (WCE) and nocturnal dipping pattern in untreated patients with uncomplicated essential hypertension using 24-hour ambulatory BP monitoring (ABPM). Methods: Seventy-five newly diagnosed, untreated essential hypertensive subjects (54 men, 21 women 47.6+/-9.3 years) were recruited for the study based on conventional measured BP from a total of 180 patients referred for ABPM. Of these, 65 patients underwent repeated ABPM after 4 weeks observation without treatment. Reproducibility of BP, nocturnal dipping pattern, WCE and BP variability were assessed using different methods. Results: The average 24-hour BP (140.8+/-11.9/91.8+/-6.4 vs. 140.5+/-14.5/90.7+/-7.6 mmHg, ns) or PP (49.6+/-10.8 vs. 49.8+/-9.8 mmHg, ns) did not change, nor did daytime BP or PP. The WCE diminished significantly during the observation period (reduction in SBP WCE Delta8.2+/-12.5 mmHg, p<0.0001, in DBP WCE, Delta 3.3 +/- 9.2 mmHg, p=0.008 and in PP WCE Delta 4.8 +/- 11.2 mmHg, p=0.002). Variability in SBP, DBP and PP decreased consistently and significantly during the observation period. The nocturnal dipping pattern was unchanged in 82% of the patients. In 12% non-dipping pattern was converted to dipping pattern after repeated measurement. Conclusion: Average ABPs are highly reproducible in patients with uncomplicated essential hypertension of limited duration. Similarly, nocturnal dipping pattern reproduced satisfactorily. These measures have important clinical applicability. The white-coat effect as well as variability are greatly attenuated during repeated measurements, and these measures may thus be of less utility in clinical practice.