Assuming that patients with isolated clinic normotension exhibit elevated blood pressures during most of their daily life (except when in the clinic of course!), it could be hypothesized that patients with these blood pressure profiles possess the same target organ pathology and elevated risk for cardiovascular disease as individuals with untreated essential hypertension.

Although a lot of data have not been gathered to test this hypothesis, the evidence that exists shows that isolated clinic normotensive patients indeed exhibit the same target organ pathology as patients with sustained essential hypertension (Liu et al., 1999; Sega et al., 2001). Liu et al. (1999) reported comparable indices of left ventricular hypertrophy and carotid artery atherosclerosis as well as numerous blood assays (glucose level, cholesterol level, creatinine concentration) between isolated clinic normotensive and essential hypertensive patients.

Both hypertensive groups exhibited a greater incidence of left ventricular hypertrophy, plaque development in the carotid arteries, and increased levels of serum glucose and cholesterol than normotensive controls, lending support to the hypothesis that isolated clinic normotension is associated with increased risk for cardiovascular disease consequences. By using data from the PAMELA Study, Sega et al. (2001) confirmed that isolated clinic normotension is not a benign condition. As in the aforementioned findings reported by Liu et al., isolated clinic normotensive patients exhibited greater left ventricular hypertrophy than persons with normal blood pressures in all settings.

Although not many studies have examined target organ pathology in isolated clinic normotension, and no studies have yet examined the relation between actual cardiovascular disease endpoints in isolated clinic normotension, the current evidence indicates that individuals with this unique blood pressure profile exhibit risk for cardiovascular complications comparable to untreated essential hypertensive patients. In a sense, that is what they are.

Turner, S. M., Beidel, D. C., and Larkin, K. T.
Published with assistance from the foundation established in memory of Amasa Stone Mather of the Class of 1907, Yale College.