Abstract-The purpose of the present study was to evaluate whether the difference between blood pressure measured in the clinic or physician's office and the average daytime blood pressure accurately reflects the blood pressure response of the patient to the physician ("white coat effect" or "white coat hypertension"). We studied 28 hypertensive outpatients (mean age, 41.8Ϯ11.2 years; age range, 21 to 64 years) of 35 consecutive patients attending our hypertension clinic, in whom (1) continuous noninvasive finger blood pressure was recorded before and during the visit, (2) blood pressure was measured according to the Riva-Rocci-Korotkoff method (mercury sphygmomanometer) with the patient in the supine position, and (3) daytime ambulatory blood pressure was monitored with a SpaceLabs 90207 device. The peak blood pressure increase recorded directly during the visit was compared with the difference between clinic and daytime average ambulatory blood pressures. Compared with previsit values, peak increases in finger systolic and diastolic blood pressures during the visit to the clinic were 38.2Ϯ3.1 and 20.7Ϯ1.6 mm Hg, respectively (meanϮSEM, PϽ.01 for both). Daytime average systolic and diastolic blood pressures were 135.5Ϯ2.5 and 89.2Ϯ1.9 mm Hg, with both lower than the corresponding clinic blood pressure values (146.6Ϯ3.6 and 94.9Ϯ2.2 mm Hg, PϽ.01). These differences, however, were Ͻ30% of the peak finger blood pressure increases during the physician's visit, to which these increases showed no relation. Although the visit to the physician's office was associated with tachycardia (9.0Ϯ1.6 bpm, PϽ.01), there was no difference between clinic and daytime average heart rates. These data indicate that the clinicϪdaytime average blood pressure difference does not reflect the alerting reaction and the pressure response elicited by the physician's visit and thus is not a reliable measure of the white coat effect. (Hypertension. 1998;31:1185-1189.)Key Words: blood pressure monitoring, ambulatory Ⅲ stress Ⅲ risk factors Ⅲ hypertension, white coat Ⅲ blood pressure A mbulatory blood pressure monitoring has shown that in most subjects, daytime blood pressure is lower than clinic blood pressure.1-3 This difference is ascribed to the "white coat effect" (ie, the alerting reaction and pressor response of the patient to the measurement of blood pressure in the clinic environment).4,5 As a result, subjects with a clinic blood pressure of Ͼ140/90 mm Hg and a daytime blood pressure below this value are called "white coat hypertensives." 6,7 No demonstration has ever been given, however, that the clinicϪdaytime blood pressure difference is due to a white coat effect and therefore the term "white coat hypertension" is appropriate. In the present study, we addressed this issue by measuring in the same subjects the clinicϪdaytime blood pressure difference and the actual pressor response to blood pressure measurements by a physician in the clinic environment. Methods SubjectsThirty-five hypertensive patients were considered for inclusion in...
Thus, the clinic-daytime blood pressure difference has a limited reproducibility; depends not only on clinic but also on daytime average blood pressure, which means that its size is a function of the blood pressure criteria employed for selection of the patients in a trial; and is never associated with a systematic clinic-daytime difference in heart rate, which further questions its use as a reliable surrogate measure of the true pressor response induced in the patient by the doctor's visit.
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