WCH showed an intermediate prevalence of any TOD between NT and mild-to-moderate HT, and within WCH, higher 24-h SBP variability was associated with concurrent TOD after accounting for 24-h mean SBP and basic clinical factors.
Key Findings
Results
The prevalence of any subclinical target-organ damage differed significantly across normotension, white-coat hypertension, and mild-to-moderate hypertension groups.
Any TOD occurred in 26.4% of normotensive participants, 52.7% of white-coat hypertension participants, and 71.1% of mild-to-moderate hypertension participants.
The between-group difference was statistically significant (P<0.001).
The study included 267 hospitalized participants (91 NT, 93 WCH, 83 HT) who underwent ambulatory blood pressure monitoring between 2012 and 2021.
WCH showed an intermediate prevalence of TOD, positioned between NT and mild-to-moderate HT.
Results
Within white-coat hypertension, continuous 24-h SBP variability was independently associated with the presence of any subclinical target-organ damage.
The odds ratio for any TOD per unit increase in continuous 24-h SBP variability was 1.25 (95% CI 1.05–1.52).
The association was adjusted for age, sex, body mass index, and 24-h mean SBP.
Any TOD occurred in 35.5%, 64.5%, and 58.1% across increasing variability tertiles, though the unadjusted between-tertile comparison was not statistically significant (P=0.056).
Results
Higher 24-h SBP variability was independently associated with left ventricular hypertrophy and greater left ventricular mass index in white-coat hypertension participants.
The odds ratio for left ventricular hypertrophy (LVH) per unit increase in 24-h SBP variability was 1.30 (95% CI 1.08–1.60).
Each unit increase in 24-h SBP variability was associated with a 2.23 g/m² increase in left ventricular mass index (LVMI) (95% CI 0.33–4.12).
These associations were adjusted for age, sex, BMI, and 24-h mean SBP.
Results
Higher 24-h SBP variability was independently associated with greater log-transformed microalbuminuria in white-coat hypertension participants.
Each unit increase in 24-h SBP variability was associated with a 0.105-unit increase in log-transformed microalbuminuria (95% CI 0.052–0.157).
The association was adjusted for age, sex, BMI, and 24-h mean SBP.
Microalbuminuria (MA) was one of the TOD markers evaluated in the study.
Results
Adding 24-h SBP variability to the base model improved the ability to identify any target-organ damage in white-coat hypertension participants.
The area under the receiver operating characteristic (ROC) curve was 0.613 for the base model (age, sex, BMI, and 24-h mean SBP).
After adding 24-h SBP variability, the AUC increased to 0.678.
The extended model showed better overall fit compared to the base model (likelihood-ratio P=0.009).
Conclusions
This study was a single-center retrospective cross-sectional design, which limits causal inference.
The authors explicitly noted that 'these single-center cross-sectional findings do not establish temporal or causal relationships.'
The authors called for 'confirmation in prospective multicenter studies.'
Data were collected from hospitalized participants who underwent ambulatory blood pressure monitoring between 2012 and 2021.
The sample size was 267 participants across three groups.
What This Means
This research suggests that people with white-coat hypertension — a condition where blood pressure appears elevated in a clinical setting but is normal when measured at home — have more signs of hidden organ damage than people with genuinely normal blood pressure, but less than those with confirmed mild-to-moderate high blood pressure. Specifically, about half of white-coat hypertension patients in this study showed evidence of subclinical damage to organs such as the heart and kidneys, compared to about a quarter of truly normotensive individuals and about 70% of those with sustained hypertension. This intermediate position supports the idea that white-coat hypertension is not entirely a benign or harmless condition.
Among participants with white-coat hypertension, this study also found that greater day-long fluctuations in systolic blood pressure — known as blood pressure variability — were linked to higher rates of organ damage, including enlarged heart muscle (left ventricular hypertrophy) and small amounts of protein leaking into the urine (microalbuminuria), even after accounting for average blood pressure levels. Adding blood pressure variability to standard measures improved doctors' ability to identify which white-coat hypertension patients had organ damage, suggesting it may carry additional information beyond average blood pressure readings.
However, because this was a retrospective, single-center study based on hospitalized patients, it cannot prove that blood pressure variability causes organ damage, only that the two are associated. The findings may not apply to the general population, and the authors themselves emphasize the need for larger, prospective, multicenter studies to confirm these results before any clinical conclusions can be drawn.
Huang J, Huang Z, Huang F. (2026). Short-Term 24-h Systolic Blood Pressure Variability and Subclinical Target-Organ Damage in White-Coat Hypertension: A Retrospective Cross-Sectional Study.. Vascular health and risk management. https://doi.org/10.2147/VHRM.S626042