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This study was to assess left ventricular diastolic function in young white-coat hypertensive subjects < 50 years of age without hypertrophy. Hypertensive patients (systolic or diastolic blood pressure >or= to 140 or >or= to 90 mm Hg on all three visits) were defined as white coat if their average 24-hour blood pressure was <127/81 mm Hg and at least 18/16 mm Hg lower than their average office values. We chose three groups balanced for sex, age, and body mass index50 sustained hypertensives, 25 white-coat hypertensives, and 25 normotensives. Office blood pressure was similar in white-coat and sustained hypertensives. Ambulatory blood pressure was comparable in white-coat hypertensives and normotensives. Compared with normotensives, white-coat hypertensives had more impaired diastolic functionincreased ratio of late to early filling velocities, raised ratio of late to early time-velocity integral, prolonged deceleration time, and lengthened isovolumic relaxation time (P < .001, P < .001, P = .002, and P < .001, respectively). No difference was noticed between white-coat and sustained hypertensives. Compared with normotensives, white-coat hypertensives had higher values of plasma and urine norepinephrine (P <.001 and P < .001, respectively), plasma and urine aldosterone (P < .001 and P = .002, respectively), plasma renin activity (P = .04), total cholesterol (P = .001), and LDL cholesterol (P < .001). No difference was observed between white-coat and sustained hypertensives. Within white-coat hypertensives, 24-hour urinary aldosterone closely correlated with the ratio of late to early filling velocities (P = .008), and plasma and 24-hour urinary norepinephrine correlated well with total cholesterol (P = .037 and P = .006, respectively). No correlation was detected within the sustained hypertensives and normotensives. Heightened neurohumoral activity clearly supported the progression of diastolic dysfunction and metabolic abnormality in white-coat hypertensives. (Hypertension. 1997;30[part 2]:746-752.)