White coat hypertension in definition of metabolic syndrome.

Although white coat hypertension (WCH) is believed to have an effect on health, there is no term defining WCH in metabolic syndrome. Consecutive patients 20 years old or older who underwent a check-up were included. The study included 1068 cases. The prevalences of hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, impaired glucose tolerance (IGT), and WCH were similar to excess weight in that they increased significantly until the seventh decade of life and decreased thereafter significantly (P < 0.05 in most steps). On the other hand, the prevalences of hypertension (HT), diabetes mellitus (DM), and coronary heart disease (CHD) always increased significantly with age without any decrease (P < 0.05 in most steps), indicating their irreversibility in contrast to the reversibility of excess weight, hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, IGT, and WCH. Metabolic syndrome is a reversible progression step between health and irreversible final diseases terminating with increased mortality and disabilities. Thus, the definition of metabolic syndrome should include reversible metabolic risk factors such as excess weight (overweight and obesity), hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, IGT, and WCH, instead of irrevesible diseases such as DM, HT, CHD, and stroke that have already developed and require drug therapy. After development of one of the final metabolic diseases, the term metabolic syndrome probably loses most of its significance, since from that point on, nonpharmaceutical approaches such as lifestyle changes, diet, and exercise will provide little benefit to prevent development of the others, most likely due to the cumulative effects of the risk factors on body systems over a long period of time.

Metformin and parameters of physical health.

BACKGROUND: The prevalence of excess weight, including overweight and obesity, is increasing with a high cost on health in society. METHODS: Consecutive cases with excess weight, aged between 50 and 70 years and desiring weight loss, were divided into two subgroups according to wishes of patients about whether they prefer medication or just a diet. Metformin at a daily dose of 2,550 mg was given to the medication group. RESULTS: As for the very high prevalences, 84.8% (313/369) of cases at or above the age of 50 years were overweight or obese, 67.2% (248/369) of them had white coat hypertension (WCH) or hypertension (HT), 52.5% (194/369) of them had impaired glucose tolerance (IGT) or diabetes mellitus (DM), and 68.8% (254/369) of them had dyslipidemia. Initially 143 cases with excess weight preferred the diet and 162 of them preferred the metformin therapy. But 42 cases (25.9%) stopped the drug because of excessive anorexia. At the end of the six-month period, there were highly significant differences between the two groups according to prevalences of resolved WCH, hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, overweight, and obesity and a decreased fasting plasma glucose below 110 mg/dL (p<0.001 for all). CONCLUSION: Due to the very high prevalences of excess weight and probably many associated disorders with the excess weight, including IGT or DM, WCH or HT, and dyslipidemia, above the age of 50 years, and the detected significant benefits of metformin on all of the above parameters, metformin treatment should be initiated in patients with excess weight in their fifties.

What a high prevalence of white coat hypertension in society!

BACKGROUND: There are many patients in society using antihypertensive medication, which has been initiated just after a single office measurement but actually they are normotensive and in contrast, there are many patients not using any antihypertensive medication because of a normal blood pressure (BP) at the doctor's office but they are actually hypertensive. MATERIALS AND METHODS: We randomly took 438 consecutive patients. Clinical BP was measured by the same physician, and a 10-day twice daily home blood pressure measurement (HBPM) and 24-hour ambulatory blood pressure measurement (ABPM) were obtained. RESULTS: Among 438 patients, 170 (38%) normotension (NT), 190 (43%) white coat hypertension (WCHT), 10 (2%) masked hypertension (MHT), and 68 (15%) sustained hypertension (HT) cases were detected. Although the prevalences of sustained HT and MHT increased by decade, the prevalence of WCHT was much higher in all decades until the eighth decade. Even in the second decade, its prevalence was 33% and higher than 45% in the third, fourth, and fifth decades of life. No statistically significant difference was found for number of WCHT, MHT, and sustained HT cases between ABPM and HBPMs. CONCLUSION: HBPM should be the preferred method of diagnosis of WCHT, MHT, and sustained HT against conventional BPM at the doctor's office and even ABPM due to its simplicity and equal effectiveness with ABPM. It should be applied to every patient above the age of 40 years once a year due to high prevalences of sustained and masked HT cases. Additionally, due to the very high prevalences of WCHT even in the very early decades, WCHT should be thought of as a normal response of the body against various stresses and its management should be limited to annual follow-up with HBPMs.