Prevalence and Clinical Correlates of White Coat Hypertension among Dyslipidemic Adults Undergoing Ambulatory Blood Pressure Monitoring in a Tertiary Care Setting

Objectives: Dyslipidemia and white coat hypertension (WCH) are established cardiovascular risk factors that frequently co-exist, yet their combined burden remains underexplored in South Asian populations. Inaccurate office blood pressure (BP) readings in dyslipidemic patients may result in overtreatment or missed hypertension, emphasizing the value of ambulatory blood pressure monitoring (ABPM). The true prevalence of WCH among dyslipidemic individuals in Pakistan is currently unknown. This study aimed to determine the prevalence of WCH in adults with dyslipidemia undergoing ABPM and to evaluate its association with lipid profile parameters. Methodology: A cross-sectional study was conducted at a tertiary care hospital including 191 adults with dyslipidemia who underwent 24-hour ABPM between January and June 2025. Demographic, clinical, and biochemical parameters were obtained from electronic medical records. WCH was defined as elevated office BP with normal daytime and nighttime ambulatory BP values. Lipid fractions were compared between WCH and non-WCH groups. Logistic regression was used to adjust for confounders. Results: The cohort was predominantly male (65.4%), with a mean age of 54.00±11.39 years. High cardiometabolic risk was evident, with diabetes mellitus (82.7%), coronary artery disease (80.6%), and smoking (74.4%) being common comorbidities. The prevalence of WCH was 27.2%. A loss of nocturnal dipping occurred in 78.5% of participants. Elevated LDL-C (≥100 mg/dL) was significantly associated with WCH (p = 0.047), whereas total cholesterol, triglycerides, and HDL-C showed no significant associations. Conclusion: WCH is common among dyslipidemic adults, highlighting the importance of confirmatory ABPM in this high-risk population. Elevated LDL-C appears to have a distinct association with WCH, suggesting that lipid abnormalities may influence BP reactivity. Early identification of WCH may improve cardiovascular risk stratification and prevent misdiagnosis or inappropriate treatment. Further multicenter studies are required to validate these findings across broader populations.