Drs Kario and Pickering raise several reasonable points. First, they suggest that we could have used a criterion defining normal daytime ambulatory BP of 135/85 mm Hg or lower, rather than 140/90 mm Hg or lower. Regardless of the criterion used, our group with white-coat hypertension had normal ambulatory BP (mean, 129/80 mm Hg), and was carefully matched to normotensive controls (mean ambulatory BP 128/80 mm Hg).
Second, Drs Kario and Pickering would have preferred stricter exclusion of individuals with diabetes. Among our group with white-coat hypertension, 3 participants met current criteria for diabetes, though none were receiving drug therapy, and their mean fasting glucose level was just 7.5 mmol/L (135 mg/dL). As noted in the "Results" section, the mean carotid plaque score of these 3 individuals was identical to that of the rest of the white-coat hypertension group. Thus, the inclusion of mild diabetes did not materially affect our results.
Muldoon MF, Manuck SB. White-Coat Hypertension or White-Coat Hypertension Syndrome: Which Is Accompanied by Target Organ Damage?—Reply. Arch Intern Med. 2000;160(22):3495–3496. doi:
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