Closer look at white-coat hypertension

Abstract

This review aims to clarify novel concepts regarding the clinical and laboratory aspects of white-coat hypertension (WCHT). Recent studies on the clinical and biological implications of WCHT were compared with existing knowledge. Studies were included if the WCHT patients were defined according to the 2013 European Society of Hypertension guidelines, i.e., an office blood pressure (BP) of ≥ 140/90 mmHg, a home BP of ≤ 135/85 mmHg, and a mean 24-h ambulatory BP of ≤ 130/80 mmHg. WCHT studies published since 2000 were selected, although a few studies performed before 2000 were used for comparative purposes. True WCHT was defined as normal ABPM and home BP readings, and partial WCHT was defined as an abnormality in one of these two readings. The reported prevalence of WCHT was 15%-45%. The incidence of WCHT tended to be higher in females and in non-smokers. Compared with normotensive (NT) patients, WCHT was associated with a higher left ventricular mass index, higher lipid levels, impaired fasting glucose, and decreased arterial compliance. The circadian rhythm in WCHT patients was more variable than in NT patient's, with a higher pulse pressure and non-dipping characteristics. Compared with sustained hypertension patients, WCHT patients have a better 10-year prognosis; compared with NT patients, WCHT patients have a similar stroke risk, but receive more frequent drug treatment. There are conflicting results regarding WCHT and markers of endothelial damage, oxidative stress and inflammation, and the data imply that WCHT patients may have a worse prognosis. Nitric oxide levels are lower, and oxidative stress parameters are higher in WCHT patients than in NT patients, whereas the antioxidant capacity is lower in WCHT patients than in NT patients. Clinicians should be aware of the risk factors associated with WCHT and patients should be closely monitored especially to identify target organ damage and metabolic syndrome. Key words: White-coat hypertension; Ambulatory blood pressure; Target organ damage; Glucose dysregulation Core tip: There is contradictory information regarding the clinical presentations and prognosis of white-coat hypertension (WCHT). This review aims to summarize recent research and compare it to existing knowledge about WCHT. Published studies on the prevalence of WCHT, the associated target organ damage and cardiovascular markers, and WCHT patient prognosis were reviewed. WCHT may be a marker of future obesity and metabolic syndrome, is related to glucose dysregulation and left ventricular hypertrophy and may progress to sustained hypertension. Clinicians should be aware of the risk factors associated with WCHT, and patients should be closely monitored, especially to identify target organ damage and metabolic syndrome.Sipahioglu NT, Sipahioglu F. Closer look at white-coat hypertension. World

White coat hypertension: improving the patient–health care practitioner relationship

“…This was not quantitatively researched until 1983, when researchers recorded intra-arterial blood pressure in hospitalized patients over the course of a 24-hour period. 4 , 18 Researchers found that the appearance of a physician was accompanied by an immediate increase in a patient’s blood pressure and heart rate. The patient’s blood pressure peaked 2–4 minutes after the start of the visit and remained high throughout the duration of the physician’s visit.…”

“…According to the 2013 European Society of Hypertension/Society of Cardiology guidelines, white coat hypertension characterizes individuals with office systolic/diastolic blood pressure measurements of 140/90 mmHg or higher on at least three occasions, with normal ambulatory or home blood pressure readings (24-hour ambulatory blood pressure <130/80 mmHg or a home blood pressure reading of 135/85 mmHg). 3 , 4 On the other hand, the Eighth Joint National Committee in the United States maintains that hypertension should be treated pharmacologically in those individuals older than 60 years who have systolic/diastolic blood pressure measurements of 150/90 mmHg or higher and those younger than 60 years with systolic/diastolic blood pressure measurements of 140/90 mmHg or higher. 5 However, because of the various numerical measurements used to diagnose white coat hypertension in the past literature, previous research has documented diverse effects on patient care and treatment.…”

White coat hypertension in well‐controlled hypertensives during dental surgery‐ A case series

“…White coat hypertension is the state of an untreated person in which the blood pressure measured in a medical environment indicates hypertension, while the blood pressure measured outside of the medical environment is in the normal range. 1,2 Juhee et al reported this phenomenon to be attributable to the anxiety experienced by a patient during a clinic visit. 3 Furthermore, white coat hypertension can also be exhibited by well-controlled hypertensives who…”

A Comparison of Casual In-Clinic Blood Pressure Measurements to Standardized Guideline-Concordant Measurements in Severely Obese Individuals

“…Common additional errors include taking single readings, talking while performing measurements, failing to allow a sufficient rest period prior to measurement, improper patient positioning, and terminal digit preference [ 11 , 12 ]. Most of these factors can also spuriously raise blood pressure, as can the white coat effect, which is found in 15–45% of clinic patients [ 15 , 16 ]. Overdiagnosis of hypertension and overtreatment with antihypertensive drugs are the expected consequence of falsely elevated readings.…”